Dental codes and their power to accurately code various procedures for insurance reimbursements are a major source of worry for many dental practices. For the same reason, utilizing the proper dental procedure code is essential, yet quite puzzling. Accurate dental coding is vital to submitting clean claims for timely reimbursements. Practices need to make sure the appropriate dental codes are added to the bill when creating one. Also, they need to bill the claims accurately using the most recent CDT code sets so as to minimize problems, discrepancies, and other payment barriers.
CDT codes are a series of medical codes for procedures that deal with both oral health and dentistry. These procedural codes are alphanumeric codes that start with the letter “D” and are followed by four numbers. It contains the necessary codes required to code each dental procedure for submission to a particular dental insurance plan. It is important to understand that the CDT codes undergo changes every year, and a practice must be up-to-date on the changes to the CDT codes.
The CDT code set is divided into different service types, which include:
- Removable Prosthodontics
- Maxillofacial Prosthetics
- Implant Services
- Fixed Prosthodontics
- Oral and Maxillofacial Surgery
- Adjunctive General Services
Submitting claims with accurate dental procedural codes is not an easy task; it has a lot of difficulties, which are further exacerbated by limited staff and time. Understand that your staff are not robots; they can make mistakes too. There are high chances for them to miss adding some of the dental codes to the bills, especially with their busy schedule. A lot of reasons, including time constraints, extra workload, etc., can lead to mistakes in dental coding.
Failure to use the appropriate procedure codes can complicate the entire process and result in negative patient outcomes. It is true that precise procedural coding is a legal necessity, and violators have to face severe repercussions.
When process codes are misused intentionally or unintentionally, the practices have to face a lot of challenges, including:
Delayed or denied payments
Failure to provide correct coding can lead to improper billing, causing payments to be delayed, denied, or limited. A majority of claims get denied due to such errors in procedural coding. Such claim denials can be costly, as the buildup of these denied reimbursements can result in heavy loss of revenue at your practice.
Hinders patient satisfaction
Even a small error in dental coding, such as switching the order of two digits in a code, can indicate a completely different diagnosis. Patients may think there is a scam afoot if they receive a hefty fee for a procedure they did not have. This may result in claim denials or delays that negatively impact your patient experience.
Leads to fraud and abuse fines
Improper coding on claims may have legal repercussions in addition to regulatory liabilities if the insurance carrier challenges the accuracy of the procedures submitted. If an insurance provider finds out that a practice has routinely overcharged or overtreated a patient, the practice will be subjected to disciplinary action.
Your practice can’t afford to lose tens of thousands of dollars due to unnecessary errors or inefficiencies. However, that is exactly what happens if you are using inaccurate or outdated dental codes. Therefore, it’s your practice’s responsibility to make sure that the claims are correctly coded.
So, here are some ways in which you can reduce the inaccuracies in dental coding:
Perform regular coding audits
Regular coding audits are necessary for the proper and accurate coding of dental bills to make sure that your practice receives timely reimbursements. Performing regular coding audits helps you identify areas of inefficiency in your coding process, thus providing the opportunity to find solutions to rectify the most common mistakes in coding.
Stay up-to-date on the latest CDT codes
As mentioned earlier, CDT codes undergo changes every year, so it is important for your practice to stay updated on the latest changes as dental coding mistakes can have severe repercussions.
Always check for fraud
Make sure that you check for any kind of fraud in your dental billing before submitting the claims. If the insurance companies suspect any misuse or abuse of procedure codes, your practice can face disciplinary action. It is crucial to remember that your practice is legally responsible for the accuracy of all dental claims that leave it.
For the accurate coding of dental bills, practices must make sure that the necessary information is thoroughly communicated between the provider and the billing staff. For accurate and proper coding of dental bills, the provider must clearly communicate and explain the treatments performed on patients to the billing staff. The practice could suffer financial loss or even face legal repercussions for inaccurate coding due to a lack of proper communication between the provider and the office staff. Keep in mind that coding errors are more likely to occur in practices with poor communication, which can be quite problematic.
However, keep in mind that everyone at your practice must be aware of the updated CDT codes, not just the billing staff. It can be helpful to your staff in identifying scenarios where the codes may be applicable, recognizing when it is necessary to gather more information on a particular procedure, and fully documenting the procedures so that they are eligible for billing whenever possible.