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Dental Tribune U.S. Edition

Dental Tribune U.S. Edition | March 2013 D3CLINICAL Ad procedures with their medical plans. Implementing cross coding creates greater case acceptance resulting in in- creased patient affordability and prac- tice profitability. Hygienists can play a key role in the implementation of cross coding. Hygienists can be the communicators for cross coding in their practices by alerting the practice of patients whom they believe are medically compro- mised. Such patients are excellent candi- dates for cross-coded claims. As an example, hygienists can inquire about conditions that might indicate that a patient has sleep apnea (Fig. 1). For those practices that treat sleep apnea, the practice would then need to refer the patient for a sleep study before com- mencing treatment. If the practice does not treat sleep apnea, this referral 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 implement 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. Dental, medical claims differences There are significant differences between dental and medical claims. The biggest difference is that, at present, medical in- surance is diagnosis driven while dental insurance is not as of yet. Medical insurance uses diagnosis codes to explain why a procedure was performed. Without at least one appro- priate diagnosis 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 num- bers of dentally related diagnosis codes, which are very helpful when cross cod- ing. However, it is not so easy to use the CPT codes because there are so few den- tal CPT codes. This is the area that makes cross coding more difficult. The medical claim form is a bit different than the den- tal 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 diagnosis codes and six procedure codes. There are also other codes within these code systems that are used to give further diagnostic information or to pro- vide information on why a procedure might have been modified by a specific circumstance. As you can see, cross coding is not an easy system to implement. The answer to easing the difficulty with cross coding is to take a good course on the topic. You also can check out my website to see the different tools available to help dental practices implement cross coding. Increased opportunities with medical insurance As mentioned already, the patient’s ben- efit from cross coding is that medically necessary dental procedure can be made more affordable. It is possible to file the tests already mentioned with a patient’s medical in- surance plan. There are diagnosis and procedure codes that apply to these tests, but those are too involved for the scope of this article to provide 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, “the existence of a code does not, of itself, determine coverage or non- coverage.”3 It is certainly worth the effort of a phone call to determine coverage. I al- ways advise practices that cross code and receive negative responses to encour- age their patients to complain to their employers. Insurance contracts are be- tween the insurance company and the employer, so dental practices have little power to make any plan changes. Howev- er, the more that complaints are issued, the more likely that medical insurance carriers will begin to see the necessity for including these types of procedures in their plans. More cross-coding procedures The full scope of cross coding is much more extensive 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 pro- cedures • Medically necessary implant and peri- odontal procedures • Exams, radiographs and diagnostic procedures for any medically neces- sary dental procedure Postive changes to your career Between implementing disease testing and cross coding, a hygienist will sig- nificantly make positive changes to his or her career. These hygienists will not only help patients obtain optimal health, but they can also help make procedures more affordable. Patients will be able to see that their dental practice truly cares about their health and will have more confidence in the practice. This is a true win-win situ- ation. The dental practice will value the contributions of these hygienists, and hygienists will rarely face each day with that “same-old, same-old” feeling. Editorial note: This article is reprinted from Vol. 1, No. 1, 2012, Hygiene C.E. magazine. ˙ References 1. Dentists can help patients at risk of fatal heart attack, /redirect.asp?itemid=303206&wf=33ing, accessed July 7, 2012. 2. Zaromb A, Chamberlain D, Schoor R, et al. Periodontitis as a manifestation of chronic benign neutropenia. J Periodontol. 2006;77:1921–1926. 3. Common Procedure Coding System (HCPCS) Level II coding procedures. Cen- ters for Medicare and Medicaid Services website. Available at: MedHCPCSGenInfoHealthcare/Downloads/ LevelIICoding Procedures113005.pdf, ac- cessed Oct 24, 2006. ◊ OVERALL, page D2