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Patti DiGangi, RDH, BS, believes dentistry is no longer just about fixing teeth. Dentistry is oral medÂicine. Her work helps dental professionals embrace the opportunities and understand the metrics that accurate insurance coding provides. The ADA recognized her expertise by inviting her to write a chapter in its CDT 2017 Companion book and again for its CDT 2018 Companion. She is the author of the DentalCodeology series of easy-to-read, bite-size books. Her latest book, "Teledentistry: Pathway to Pathology" was co-written with Cindy Purdy, RDH, BS. She can be reached at firstname.lastname@example.org.
"It isn’t difficult, but it takes team cooperation, new thinking, and practice." That's the mantra from author Patti DiGangi in this article.
Time magazine has a Top Ten of Everything in its Arts and Entertainment list. No doubt, Star Wars: The Force Awakens will eventually top the movie list for 2015 (and maybe of all time). Topping the 2015 dental professional frustration list (and maybe of all time) is dealing with insurance. In 2016, practices can optimize CDT coding, be prepared to cross-code medical (including Medicare), and prepare for merging of dental and medical records with one simple change: routine documentation of the dental-medical necessity for care-Twitter-style.
Twitter-style … Less is more
One of the best ways to improve your writing is to cut unnecessary words. Many people tend to overwrite, similarly to how they speak. In March 2016, the online social network Twitter will celebrate its 10th anniversary. Twitter taught users to send and read short 140-character messages. That isn’t 140 words or even 140 letters … it’s 140 characters, including letters, numbers, symbols, punctuation, and spaces. Twitter writing squeezes the excess, leaving only the nourishing juice.
Like tweets, dental-medical necessity is concise writing.
Sample: High risk pregnancy. High risk caries. Plaque induced gingival disease modified by systemic factors-pregnancy, #14-15 Chronic Periodontitis 2mm bone loss
That is a 153-character dental-medical necessity that gives medical information, risk assessment, and a periodontal diagnosis. It isn’t difficult, but it takes team cooperation, new thinking, and practice.
Why dental-medical necessity?
Many studies in recent years have investigated the relationship between oral and systemic conditions. An increasing number of dental carriers are recognizing the medical nature of certain dental procedures. Dental-medical necessity is the reason why a test, a procedure, or an instruction is given. Dental-medical necessity is different from person to person and changes over time. It is beneficial to all practices to document it routinely to help optimize dental benefit coverage and cross-coding opportunities.
Polypharmacy … those long, long lists of medications that our patients take every day that often contribute to dry mouth. Lack of saliva is much more than just irritating; it can be a contributing factor in caries infection, oral cancer, and periodontal disease. This means the medications themselves (as well as what they treat) are part of the dental-medical necessity.
Sample: Diabetes & Coronary artery disease. Vasotec, Topamax, Albuterol, Lipitor, 81mg. aspirin. Extreme oral dryness.
This patient’s dental-medical necessity is evident with this concise, specific 111-character tweet. It isn’t difficult, but it takes team cooperation, new thinking, and practice.
Continue to page two for more...
Diagnostic images tweeting
Practices have been getting notices from dental benefit carriers questioning the number and frequency of diagnostic images. Taking images based on a calendar has long been the routine in dentistry. Radiographic Recommendations is a resource created by the Food and Drug Administration (FDA) and updated in 2012. It states: “Radiographic screening for the purpose of detecting disease before clinical examination should not be performed.” Diagnostic images should be ordered by the dentist based on the examination. Benefit carriers, through utilization review, have begun to ask for the documentation of the reason and result for images. What can make all the difference? The dental-medical necessity.
Sample: Endodontic treatment #19. Clinical evidence of periodontal disease with generalized tissue bleeding.
This statement is only 101 characters with two reasons from the guidelines to take radiographic images. It isn’t difficult, yet takes team cooperation, new thinking, and practice.
Tweeting takes the whole team
Documenting a patient’s dental-medical necessity is not the role of the administrative team member alone. It can’t be, though it starts and ends with the administrative person. Here are the six circular steps that touch everyone in the practice.
1. From the phone call, the administrative person documents the patient’s chief concern, one of the most important aspects of dental-medical necessity.
2. The dentist orders tests and risk assessment.
3. The assistant or hygienist performs risk assessment and tests.
4. The dentist interprets results risk assessment and tests and makes diagnosis and orders treatment.
5. The dentist, assistant, and hygienist work together to concisely document steps 2-4, which is the dental-medical necessity.
6. The administrative person transfers step 5 (dental-medical necessity) to insurance submissions.
It isn’t difficult, but it takes team cooperation, new thinking, and practice.
One simple change
Often we read articles hoping for that one simple step. A simple change has been offered yet, as Steve Jobs said, “Simple can be harder than complex: You have to work hard to get your thinking clean to make it simple. But it’s worth it in the end because once you get there, you can move mountains.” Twitter-style documenting dental-medical necessity isn’t difficult, but it takes team cooperation, new thinking, and practice. Perhaps in 2016, taking this simple approach can move insurance down on the frustration list and one day remove it altogether.
To learn more, order and read DentalCodeology: Jump Start Diagnostic Coding by Patti DiGangi and Christine Taxin.