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Dental Tribune Middle East & Africa Edition

9Dental Tribune Middle East & Africa Edition | May - June 2014 mcme Marianne Harper is the CEO of The Art of Practice Management. Her areas of expertise include revenue and collection systems, business office systems and the training of dental practices in dental/medical cross coding. Harper is a consultant, trainer, lecturer and author. Her pub- lished works include “CrossWalk- ing — A Guide Through the Cross Walk of Dental to Medical Cod- ing” 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 den- tal journals. Contact her at: The Art of Practice Manage- ment, 2217 Fox Horn Road, New Bern, N.C., 28562, or by email at a.p.m.1@suddenlink.net. About the Author < Page 8 Fig. 2 Blank, original CMS-1500 form, which is printed in red ink, provides spaces for at least four diagnosis codes and six procedure codes. Codes within these code systems provide further diagnostic information or details on why a procedure might have been modified. The complexity serves as fair warning that cross coding is not an easy system to implement. coding is a cutting edge insur- ance system whereby dental practices can file a patient’s medically necessary dental procedures with their medical plans. Implementing cross cod- ing creates greater case accept- ance resulting in increased pa- tient affordability and practice profitability. Hygienists can play a key role in the implementa- tion of cross coding. Hygienists can be the communicators for cross coding in their practices by alerting the practice of pa- tients whom they believe are medically compromised. 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 commencing treat- ment. If the practice does not treat sleep apnea, this referral would at least get the ball roll- ing for treatment by another provider. Hygienists can also be the champions for cross coding by encouraging that their prac- tices 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. There are significant differenc- es between dental and medical claims. The biggest difference is that, at present, medical insur- ance is diagnosis driven while dental insurance is not as of yet. Medical insurance uses di- agnosis codes to explain why a procedure was performed. Without at least one appropri- ate diagnosis code, a claim will not be paid. The diagnosis codes are titled ICD-9-CM. The proce- dure codes are titled CPT codes. At present, there are growing numbers of dentally related di- agnosis codes, which are very helpful when cross coding. However, it is not so easy to use the CPT codes because there are so few dental CPT codes. This is the area that makes cross coding more difficult. The med- ical claim form is a bit different than 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 diagnosis codes and six procedure codes. There are also other codes within these code systems that are used to give further diagnostic infor- mation or to provide informa- tion on why a procedure might have been modified by a spe- cific circumstance. As you can see, cross coding is not an easy system to implement. The an- swer to easing the difficulty with cross coding is to take a good course on the topic. You also can check out my website, www. artofpracticemanagement.com, to see the different tools avail- able to help dental practices im- plement cross coding. As mentioned already, the pa- tient’s benefit from cross cod- ing 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 insur- ance plan. There are diagnosis and procedure codes that apply to these tests, but those are too involved for the scope of this ar- ticle to provide all of the codes needed. There is no guarantee that these tests would be cov- ered by the plan. According to the Centers for Medicare and Medicaid Services, “the exist- ence of a code does not, of it- self, determine coverage or noncoverage.”3 It is certainly worth the effort of a phone call to determine coverage. I always advise practices that cross code and receive negative responses to encourage their patients to complain to their employers. In- surance contracts are between the insurance company and the employer, so dental prac- tices have little power to make any plan changes. However, the more that complaints are is- sued, the more likely that medi- cal insurance carriers will begin to see the necessity for includ- ing these types of procedures in their plans. 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 endo- dontic procedures • Medically necessary im- plant and periodontal pro- cedures • Exams, radiographs and di- agnostic procedures for any medically necessary dental procedure Between implementing disease testing and cross coding, a hy- gienist will significantly make positive changes to his or her career. These hygienists will not only help patients obtain op- timal health, but they can also help make procedures more affordable. 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” feel- ing. References 1. Dentists can help patients at risk of fatal heart attack, available at www.drbicus- pid.com/redirect/redirect. sp?itemid=303206&wf=33ing, accessed July 7, 2012. 2. Zaromb A, Chamberlain D, Schoor R, et al. Periodontitis as a manifestation of chronic be- nign neutropenia. J Periodontol. 2006;77:1921–1926. 3. Common Procedure Coding System (HCPCS) Level II coding procedures. Centers for Medi- care and Medicaid Services website. Available at: www.cms. hhs.gov/MedHCPCSGenInfo- Healthcare/Downloads/LevelII- Coding Procedures113005.pdf Accessed Oct 24, 2006. mCME SELF INSTRUCTION PROGRAM CAPP together with Dental Tribune provides the opportunity with its mCME- Self Instruction Program a quick and simple way to meet your continuing education needs. mCME offers you the flexibility to work at your own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. Membership: Yearly membership subscription for mCME: 600 AED One Time article newspaper subscription: 100 AED per issue. After the payment, you will receive your membership number and Allowing you to start the program. Completion of mCME • mCME participants are required to read the continuing medical education (CME) articles published in each issue. • Each article offers 2 CME Credit and are followed by a quiz Questionnaire online, which is available on http://www. cappmea.com/mCME/questionnaires.html. • Each quiz has to be returned to events@cappmea.com or faxed to: +97143686883 in three months from the publication date. • A minimum passing score of 80% must be achieved in order to claim credit. • No more than two answered questions can be submitted at the same time • Validity of the article – 3 months • Validity of the subscription – 1 year • Collection of Credit hours: You will receive the summary report with Certificate, maximum one month after the expiry date of your membership. For single subscription certificates and summary reports will be sent one month after the publication of the article. 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