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    What 2018 means for insurance coding

    What you need to know, what you can ignore and how to keep from getting into trouble.


    Attention to detail

    There are a lot of specifics involved in dental coding, and paying attention to detail will help the practice, the patients and the overall coding system. First, pay attention to patients’ specific insurance plans.

    “We still fall back in the habit of treating an insurance policy versus treating a patient,” DiGangi observes. “The problem is we often don’t even know what that insurance policy reads.”

    She uses an example from her lectures where she asks attendants what type of car insurance they have.

    “One will tell me State Farm, another will tell me GEICO and the third will tell me someone else,” she says. “So that means, if we get in a car accident, that we have coverage over certain things, and they automatically say, ‘No, we don’t because we have different policies.’ Well, that’s just as true as in dental. What happens is we treat policies because we think, ‘Well, Delta doesn’t cover that.’ That could be very wrong. Our job is not to treat an insurance policy; our job is to treat the patient and code it accurately. If there is coverage under their insurance policy, wonderful.”

    Utilizing the proper codes helps ensure that the system provides what it needs.

    Read more: The next big thing in dentistry is already here

    “We only use a limited number of codes, rather than using all of them that are available, based on what we think the insurance is going to pay,” DiGangi says. “An example would be oral hygiene instructions. Teaching somebody how to take care of their mouth is pretty important, probably the most important prevention thing we can do, but that’s probably one of the least used codes: D1330. And how we code affects what codes we get; it affects the coverage for codes. Our behavior makes a difference to the system.”

    “When these codes are created by the CDT, we need to be using them as providers,” Sanders adds. “We need to be billing them out to show that we are using these codes, otherwise they’re going to go through review and they may begin to start throwing some of these codes out that are heavily unused. There are a lot of insurance companies that do reimburse for some kind of oral cancer screening therapy like OralID, VELscope or ViziLite one time a year. And I think that gets missed a lot. We’re not performing risk assessments on our patients in office. We are not evaluating their risk for HPV, their tobacco habits, their alcohol intake habits, things like that.”

    Paying attention to what’s going on should also extend beyond the practice’s walls.

    “I don’t think there is enough obsessing over what goes on outside of the office,” Duncan says. “I think we obsess way too much over what’s going on inside our office and we don’t see things like network changes coming at us. That can really throw our office for a loop when, all of a sudden, their fee schedules are dropped and they have no idea why. I think diligence is really, really smart. A lot of people, though, never look outside their offices to see what’s going on. So, to me, it’s more of, ‘Hey, what are the other offices down the street experiencing? What are the new networks coming into your area? What are the new employers coming into your area and what plan do they have?’ and then, ‘What are the companies that are going out of business?’ And they’re leaving and all of a sudden those patients don’t have insurance. So, to me, it’s more of what they don’t look at outside of the office than what is inside the office.”

    Like every year, coding and insurance changes can be a nuisance and a headache, but if they are tackled head-on, they can be less of a chore and more of an opportunity to benefit the practice, the patients and, ultimately, the coding system, itself.

    Robert Elsenpeter
    Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author ...


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