Dental insurance companies require CDT (Current Dental Terminology) codes on claims, while medical insurance companies require CPT (Current Procedural Terminology) codes, which “[describes] medical treatment,” on their claims (“Billing medical plans for dental treatment” 2016). Medical insurance companies also need an additional code: the ICD (International Classification of Diseases) codes, which “[describes] the condition presented by a patient for which treatment was rendered” (“Billing medical plans for dental treatment” 2016). Some dental procedures may consist of several codes billable to medical insurance and more codes can mean higher coverage for the patient (“Billing Medical Insurance for Dental Services” 2016). Diagnosis codes help patients receive coverage for patients.
Dentists should know the ICD codes for medical billing. They have to use the ICD-10CM (Clinical Modification), which “are used for all health care settings, particularly outpatient care,” and ICD-10PCS (Procedure Coding System), which “are used in hospital inpatient settings” (“Billing medical plans for dental treatment” 2016). The dental claim form has a space for diagnostic codes, but most dental insurance companies do not need them (“Billing medical plans for dental treatment” 2016). Though, dental insurance may require “diagnostic reasons for dental procedures… during narrative submission with claims, and during claim appeal process…” (“Billing Medical Insurance for Dental Services” 2016). Dentists can use many of the ICD codes, such as those under the categories K00 to K95, which not only “describe diseases of the digestive system,” but also “includes diseases of the mouth, including conditions treated by dentists” (“Billing medical plans for dental treatment” 2016). Without the ICD codes, medical insurance companies would deny the claim because the ICD codes “support medical necessity of procedure codes…” (“Billing Medical Insurance for Dental Services” 2016; Philhower and Blair 2016).
These codes justify why medical insurance should provide coverage. Medical insurance usually pays for procedures addressing “a diagnosed medical condition…” (Taxin 2016b). For instance, dentists that diagnose a condition such as an “‘abscessed tooth’” must treat it by extracting this tooth (Taxin 2016a). Medical insurance can cover this extraction when the diagnosis, which shows why the treatment is needed, and treatment are both included in the claim (Taxin 2016a). For treating sleeping apnea, dentists need to report the physician’s diagnosis, which “would be obstructive sleep apnea, denoted by the ICD code G47.33,” for the claim (“Medical Billing Codes for Dental Sleep Medicine”). Then, the dentist reports the treatment code, CPT code E0486, for “oral appliance therapy with a custom-made appliance” (“Medical Billing Codes for Dental Sleep Medicine”). Though, dentists must provide documentation from the patient record in order to justify the diagnosis code in the claim (Bradley 2014). The ICD codes must also correspond with the CPT codes (“Billing Medical Insurance for Dental Services” 2016).
Dentists can ask the insurance companies for “information requirements for certain procedures before the claim is submitted during the coverage verification process (pre-certification and re-authorization)” (“Billing Medical Insurance for Dental Services” 2016). Claims with accurate ICD codes help ensure that patients receive medical coverage for their treatments.
Works Cited
Bradley, Terri. “Dental coding ICD-10 CM – Time to prepare your practice now!” DentistryiQ,
November 17, 2014. https://www.dentistryiq.com/articles/2014/11/dental-coding-icd-10-cm-time-to-prepare-your-office-now.html.
“Billing Medical Insurance for Dental Services.” Dental Claims Cleanup, LLC, December 10,
“Billing medical plans for dental treatment.” cda, May 25, 2016.
https://www.cda.org/news-events/billing-medical-plans-for-dental-treatment.
“Medical Billing Codes for Dental Sleep Medicine.” Nierman Practice Management. Accessed
January 31, 2019. https://niermanpm.com/medical-billing-codes-dental-sleep-medicine/.
Philhower, Jim and Charles Blair. “Submitting dental procedures to medical insurance has been
voodoo—until now.” Dental Economics, September 22, 2016. https://www.dentaleconomics.com/articles/print/volume-106/issue-9/practice/submitting-dental-procedures-to-medical-insurance-has-been-voodoo-until-now.html.
Taxin, Christine. “Dental Offices – Billing Medical Insurance for covered procedures.” Find-A-
Code, September 12, 2016a. https://www.findacode.com/articles/dental-offices-billing-medical-insurance-for-covered-procedures-29897.html.
Taxin, Christine. “What makes it medical? A basic guide to medical vs. dental procedures.”
DentistryiQ, June 22, 2016b. https://www.dentistryiq.com/articles/2016/06/what-makes-it-medical-a-basic-guide-to-medical-vs-dental-procedures.html.
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