what do dental coders do?
dental coders review clinical documentation and ensure that the appropriate cdt®, cpt®, icd-10-cm, and hcpcs level ii codes are assigned to all billable services performed by the dentist.
what do dental billers do?
Dental billers are responsible for creating claims based on the codes provided, submitting claims to the insurance company, and tracking claims to ensure the practice is properly reimbursed for dental services provided .
Both dental billers and coders need to understand the difference in submission and processing guidelines between the respective insurance carriers (ie, dental vs. medical insurers, and commercial payers vs. government payers).
what does cdt mean?
cdt® stands for current dental terminology. In August 2000, CDT® was designated by the federal government as the national code set for reporting dental services in claims submitted to third-party payers, consistent with the authority granted by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). ).
the american dental association (ada) created the cdt® code set and, as the copyright owner of the cdt®, makes all decisions regarding revisions, deletions, and additions to the dental code. the ada updates the code set annually.
Third party payer payment to dental providers is based on CDT® codes and is reported on the 2019 ADA claim form. Reported codes must be current to maintain HIPAA compliance and receive reimbursement.
Do dental claims require icd-10 diagnosis codes?
not all dental insurance companies require icd-10-cm codes. However, an increasing number of dental payers, including Medicaid dental programs, require diagnosis codes on claims.
do you need icd-10-cm training to work as a medical coder and biller for a dental practice?
Proper reporting of ICD-10-CM codes requires knowledge of ICD-10-CM coding. dental coders must understand all coding guidelines, as well as the conventions for accurately selecting diagnostic codes.
Among more than 73,000 codes in the icd-10-cm codebook, approximately 750 apply directly to dentistry. These codes provide the ability to capture descriptive information for various types of patient encounters and clinical conditions.
what is cross coding?
Cross coding is a term for health insurance billing for dental services. A patient may have dental services, diagnosed as medically necessary, billed to their health insurance plan. With medical companies increasing their dental coverage, cross-coding and billing for dental services is becoming commonplace.
Coding and billing staff must be trained in medical and dental coding. A biller cannot effectively appeal denials without a working knowledge of the CDT®, CPT®, ICD-10-CM, and HCPCS Level II guidelines. additionally, understanding bundling issues and knowledge of proper documentation requirements are essential to ensure billing compliance.
What are the specialty areas in dentistry?
- dental public health: dental public health works to prevent and control dental disease while promoting dental health through public advocacy.
- endodontics: endodontics is the diagnosis, prevention and treatment of diseases of the human dental pulp and periradicular tissues.
- oral and maxillofacial pathology: oral pathology is the identification, diagnosis and management of diseases that affect the oral and maxillofacial regions. This specialty investigates the etiology, pathophysiology and treatment results of oral diseases
- oral and maxillofacial radiology: oral and maxillofacial radiology is the radiology discipline that orders and interprets radiological images for the diagnosis and treatment of diseases in the oral region.
- oral and maxillofacial surgery: oral and maxillofacial surgery involves the diagnosis, surgical treatment of diseases, injuries and defects of the hard and soft tissues of the oral and maxillofacial region.
- orthodontics and dentofacial orthopedics: orthodontics and dentofacial orthopedics includes the diagnosis, prevention and modification of malocclusions, neuromuscular and skeletal anomalies of orofacial structures.
- Pediatric Dentistry: Pediatric dentistry provides primary and comprehensive preventive and therapeutic oral health care for infants through adolescence.
- Periodontics: Periodontics includes the health, maintenance, prevention, diagnosis, and treatment of diseases of the supporting structures and surrounding tissues in the oral region.
- Prosthodontics: Prosthodontics refers to the diagnosis, treatment, rehabilitation, and maintenance associated with missing or deficient teeth and oral and maxillofacial tissues using dental prosthetics.