hygiene - the international C.E. magazine of dental hygiene

I 17hygiene 1_2012 C.E. article_ cross coding I tientforasleepstudybeforecommencingtreatment. Ifthepracticedoesnottreatsleepapnea,thisreferral would at least get the ball rolling for treatment by another provider. Hygienists can also be the champions for cross coding by encouraging that their practices imple- ment a cross-coding system. In most practices, the business office staff will need to play a significant role, but the hygienists can spearhead the process. There are significant differences between dental and medical claims. The biggest difference is that, at present, medical insurance is diagnosis driven while dental insurance is not as of yet. Medical insurance usesdiagnosiscodestoexplainwhyaprocedurewas performed.Withoutatleastoneappropriatediagno- sis code, a claim will not be paid. The diagnosis codes are titled ICD-9-CM. The procedure codes are titled CPT codes. At present, there are growing numbers of dentallyrelateddiagnosiscodes,whichareveryhelp- ful when cross coding. However, it is not so easy to usetheCPTcodesbecausetherearesofewdentalCPT codes. This is the area that makes cross coding more difficult.Themedicalclaimformisabitdifferentthan the dental claim form. It is titled the CMS-1500 form and is printed in red ink (Fig. 2). The form provides spaces for at least four diag- nosis codes and six procedure codes. There are also other codes within these code systems that are used to give further diagnostic information or to provide information on why a procedure might have been modified by a specific circumstance. As you can see, crosscodingisnotaneasysystemtoimplement.The answertoeasingthedifficultywithcrosscodingisto take a good course on the topic. You also can check out my website, www.artofpracticemanagement. com,toseethedifferenttoolsavailabletohelpdental practices implement cross coding. As mentioned already, the patient’s benefit from cross coding is that medically necessary dental pro- cedure can be made more affordable. It is possible to file the tests already mentioned with a patient’s medical insurance plan. There are diagnosis and procedure codes that apply to these tests, but those aretooinvolvedforthescopeofthisarticletoprovide all of the codes needed. There is no guarantee that these tests would be covered by the plan. According to the Centers for Medicare and Medicaid Services, “theexistenceofacodedoesnot,ofitself,determine coverage or noncoverage.”3 It is certainly worth the effortofaphonecalltodeterminecoverage.Ialways advisepracticesthatcrosscodeandreceivenegative responses to encourage their patients to complain to their employers. Insurance contracts are between the insurance company and the employer, so dental practiceshavelittlepowertomakeanyplanchanges. However, the more that complaints are issued, the morelikelythatmedicalinsurancecarrierswillbegin to see the necessity for including these types of pro- cedures in their plans. Thefullscopeofcrosscodingismuchmoreexten- sive than just these tests. Dental practices should be cross coding for the following: • Trauma procedures • Oral surgical procedures • TMD procedures • Sleep apnea procedures • Medically necessary endodontic procedures • Medically necessary implant and periodontal procedures • Exams, radiographs and diagnostic procedures for any medically necessary dental procedure Between implementing disease testing and cross coding, a hygienist will significantly make positive changestohisorhercareer. Thesehygienistswillnot onlyhelppatientsobtainoptimalhealth,buttheycan alsohelpmakeproceduresmoreaffordable. Patients will be able to see their dental practice truly cares about their health and will have more confidence in the practice. This is a true win-win situation. The dental practice will value the contributions of these hygienists, and hygienists will rarely face each day with that “same-old, same-old” feeling._ _References 1. Dentists can help patients at risk of fatal heart attack, available at www.drbicuspid.com/redirect/redirect. asp?itemid=303206&wf=33ing, accessed July 7, 2012. 2. ZarombA,ChamberlainD,SchoorR,etal.Periodontitisasa manifestationofchronicbenignneutropenia.JPeriodontol. 2006;77:1921–1926. 3. Common Procedure Coding System (HCPCS) Level II coding procedures. Centers for Medicare and Medicaid Services website. Available at: www.cms.hhs.gov/ MedHCPCSGenInfoHealthcare/Downloads/LevelIICoding Procedures113005.pdf Accessed Oct 24, 2006. Marianne Harper is the CEO of The Art of Practice Management. Her areas of expertise include revenue andcollectionsystems,businessofficesystemsandthe trainingofdentalpracticesindental/medicalcrosscod- ing. Harper is a consultant, trainer, lecturer and author. Herpublishedworksinclude“CrossWalking—AGuide Through the Cross Walk of Dental to Medical Coding” and her “Abra-Code-Dabra” series on medical cross coding for sleep apnea, TMD and trauma procedures. She also is the author of many articles published in dental journals. Contact her at The Art of Practice Man- agement,2217FoxHornRoad,NewBern,N.C.,28562, or by email at a.p.m.1@suddenlink.net. _about the author hygiene