What is dental coding?

Dental coding is the practice of using official CDT and/or ICD-10-CM procedure codes to report conditions and treatments your care team performs. These codes are required for claim reimbursement in order to remain HIPAA compliant. What you don’t know can hurt you: When you improperly or inaccurately code a procedure, you could be unintentionally committing fraud. 

Two code sets most often used in dental billing are: CDT and ICD-10-CM.

What is dental medical billing?

Dental medical billing refers to the process of billing medical insurance for care provided in your dental practice.

Sometimes the dentist performs treatments that fall under the category of medical care. For example, a dentist may treat damaged teeth, gums, and jaw due to accidents or trauma, which is considered medical care. A biopsy is another common medical treatment dentists can perform. 

Insurance claims should go to the medical insurance carrier as primary instead of dental insurance, and that’s something dental billers need to know. 

As we mentioned above, you are likely to use ICD-10-CM codes when dealing with procedures that are medical in nature. 

What is the Importance of a Dental Billing Code?

Proper dental coding is necessary to facilitate accurate reimbursement from insurance plans. Navigating the mysterious world of dental PPO and HMO plans can be very confusing to dentists and their staff. Insurance plans are constantly evolving and creating new policies to reduce their liability when it comes to making payments to dental practices for procedures that are performed on their plan’s members.

Dental practices that sign a contract with dental plans are considered in-network and enter into a contracted fee schedule. A dental practice that enters such a contract agrees to abide by the rules of the plan. The rules set forth may not always be in the favor of the dentist or patient. Regardless, a dentist signs the contract in the hopes of growing his or her practice with a constant flow of new patients, and of achieving success by providing quality care to those patients, only to be let down by the insurance companies.

Almost every corporation is asked to give a quarterly earnings report that beats expectations. As a common business model, it may seem like the only way to realistically meet those goals is to grow membership and minimize company expenses. This model yields high profits by allowing the company to hold on to their members’ insurance premiums by curbing payments made to dental practices. The policies of these dental plans tend to ultimately result in denied claims and a lack of quality care by being cost prohibitive to their members and in-network dentists.