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ICD-10-CM and Its Impact on Dentistry

Issue: Winter 2016

shutterstock 255796552800-220x220.jpg ICD-10-CM and Its Impact on Dentistry

Will dentists be required to report ICD-10-CM codes?
Now that ICD-10 has been implemented, all claims requiring a diagnosis code will require ICD-10 codes. If you do not currently report diagnoses codes on your claims, you may be minimally affected by ICD-10. It is important to note, however, that changes in health care and insurance may necessitate the use of diagnoses codes in the future. The potential changes include the following:

Centers for Medicare and Medicaid Services (CMS) mandated that effective October 1, 2015, all HIPAA- covered entities are required to implement the ICD-10 diagnosis code set. Medicaid is a HIPAA entity, as are medical and dental clinics. This mandate has been interpreted to include Medicaid dental claims; therefore, it is anticipated that state Medicaid plans will ultimately require diagnostic coding on dental claim forms. Some states are already requiring diagnoses codes or have informed their providers that they will be required in the future.

Health insurance purchased under the Affordable Care Act (ACA) has mandated pediatric dental benefits. These benefits are sometimes administered as embedded benefits through a medical policy. Some of these plans allow the dentist to file claims on the 2012 ADA Dental Claim Form using dental codes. However, an ICD-10-CM diagnosis code may also be required, and claims submitted without a required diagnosis code may be rejected.

Centers for Medicare and Medicaid Services (CMS) mandated that effective October 1, 2015, all HIPAA-covered entities are required to implement the ICD-10 diagnosis code set.

The 2012 ADA Dental Claim Form has a field for up to four diagnoses codes. As stated above, government and Medicaid dental claims will be the first to require diagnostic coding, but private payers are expected to adopt this requirement in the future. In fact, some Delta Dental plans began to require the 2012 ADA Claim Form from providers as of October 1, 2015. (Note: Dates of implementation vary by plan.) While this notification doesn’t include a requirement for using diagnoses codes, it is an indicator that this requirement is tied to ICD-10 implementation.

What should I do to prepare?
With the understanding that most dentists will eventually need to report a diagnosis code, the following basic steps are advised:

  1. Verify that your software vendor has the capability of submitting ICD-10 codes. Your software should accommodate the 2012 ADA Dental Claim Form, thus allowing proper reporting.
  2. Become familiar with the most common ICD-10 codes used in dentistry.
  3. Review your clinical documentation. Accurate clinical documentation is important to patient care and to reporting a correct diagnosis code. ICD-10 coding requires very specific information from the clinical notes, not a verbal discussion with the dentist.

The Diagnostic Coding for Dental Claim Submission Book (368-2108), available through Henry Schein, provides guidance on submitting ICD codes on dental claim forms.

About the Author: Dr. Charles Blair is the publisher of the Coding With Confidence Manual, Administration with Confidence, Diagnostic Coding for Dental Claim Submission, Insurance Solutions Newsletter, and PracticeBooster Web site.