Dental and medical insurance require different codes for their claims. Unlike dental insurance, which requires CDT codes for claims, medical insurance requires CPT (Current Procedural Terminology) codes for medical procedures and treatments and International Classification of Diseases (ICD) codes for medical diagnoses and diseases. ICD codes establish the procedure’s medical necessity. However, cross-coding in dental and medical coverage may help patients take full advantage of their benefits.
Medical insurance and dental treatment
Medical insurance may cover some dental treatments when medically necessary for patients. For medically necessary treatments practices should send the claim to health insurance first. After medical insurance reviews it, practices should send the claim and the medical insurance EOB to dental insurance. Some health insurance companies permit CDT codes to be reported on the medical claim but most required CPT codes and ICD codes must always be present on those forms.
Some services that medical insurance accepts are tooth extractions, treatment related to an infection, and sleep apnea treatments. In a 2017 CDT code update, CDT codes that medical insurance may accept include, D0414 (laboratory processing of microbial specimen to include culture and sensitivity studies, preparation, and transmission of written report) and D0600 (non-ionizing diagnostic procedure capable of quantifying, monitoring, and recording changes in structure and enamel, dentin, and cementum. Future updates to the CDT could lead to more dental services that medical insurance could cover.
Medical insurance and dental patients
Medical insurance may also yield higher coverage on dental treatments for patients. However, according to Jim Philhower, director of North America dental sales leadership and development for Henry Schein Dental, and Charles Blair, CEO of Dr. Charles Blair & Associates,” Medical coverage varies by plan. Many medical plans provide limited benefits for dental procedures. Medical plans often have high deductibles and out-of-network limitations, which decrease the actual dollar amount of reimbursement available.” Even so, Christine Taxin, founder and president of Links2Success says, “For many of your patients, medical insurance may provide better coverage and lower out-of-pocket expenses than their dental coverage for the same procedure.” With the aid of medical insurance, patients may be more willing to go through necessary dental treatments.
Despite the separation between medical and dental insurance, cross-coding represents an area of overlap between them. Fortunately, practice employees can learn more about cross-coding through books, software, and classes. There is also dental software that accepts and contains medical codes and medical claim forms. With the increasing connections between dental and medical insurance plans and their codes, clinics could help patients effectively utilize the benefits of their insurance plans even more in the future.
If you are struggling with medical dental cross coding consider partnering with eAssist. Our Success Consultants are familiar with cross-coding and will ensure claims are billed correctly. To learn more, schedule a consultation here.
