Dentalcodeology: Diagnostic Coding and Medical Necessity
As increased understanding of how systemic health issues are related to dental issues continues to rise, dental professionals are becoming ever more important in caring for patient overall health. Sharing patient’s clinical information though electronic health records (EHR) offers the best way to make the connection. For this to happen, dentistry must move to a diagnostic centered care model to be interoperable with the rest of healthcare. Coding is at the forefront of this process. Clinical professionals can no longer be hands-off with coding concerns. Coding involves the entire team because the answer to nearly every benefit coding question is diagnosis and dental-medical necessity.
EHR is not a new initiative; it has been an ongoing effort for decades. Dentistry became specifically involved, when on April 27, 2004, then-President Bush called for the majority of Americans to have EHR within 10 years and signed an Executive Order. This order included dentistry based on the information provided in David Satcher, M.D., Ph.D. then-Surgeon General, first ever Surgeon General's Report on Oral Health in May 2000. The American Recovery and Reinvestment Act (ARRA) was signed into law by President Obama on February 17, 2009. Part of that law included the Health Information Technology for Economic and Clinical Health (HITECH) Act to further promote the adoption and meaningful use of health information technology. There are multiple benefits projected when all of this comes to full fruition. Dentistry is not ready for interoperability based on current coding. For dental records to interface with other healthcare records there needs to be diagnostic coding systems. Diagnostic coding involves all part of the team including clinicians.
Dentistry has been treatment-centered with Current Dental Terminology (CDT.) The American Dental Association (ADA) has been working on SNODENT which stands for Systemized Nomenclature of Dentistry. It is a vocabulary designed to be a diagnostic companion to CDT treatment codes. This is not the only set of diagnostic codes being developed for dentistry. EZ Codes Dental Diagnostic Terminology was developed in 2009 is similar to ICD-10 and being tested in a number of dental schools. Dental practices who want to adopt a dental diagnostic code set are stuck in limbo until it is decided which set it ultimately will be chosen as the standard for dentistry.
One choice is the ‘wait-and-do-nothing approach.’ A better choice is to begin to work ‘as if.’ Anyone who has ever listened to self-help material has heard of the as if principle. The idea is that once you set a goal, begin acting as if you have already achieved it. The idea goes back to William James in the 1880’s.
Physicians, medical examiners, and coroners have used a diagnosis coding system called the International Classification of Diseases (ICD) since the early 1900’s. It was developed collaboratively between the World Health Organization (WHO) and ten (10) international centers so that the medical terms reported on death certificates can be grouped together for statistical purposes. Medicine is moving toward a goal 2014 date for implementation of ICD-10.
Billing medical insurance for oral health procedures that are medically necessary leaves dental benefits available. Cutting edge dental practices that implement cross coding have happier patients who can better afford their medically necessary dental treatment which can result in increased practice profitability due to a higher level of case acceptance. Embracing medical cross coding also brings dentistry further into the medical world by speaking the language of medicine.
Founding AAOSH members, Patti DiGangi, expert clinician and futurist teamed-up with Christine Taxin, professional dental-medical consultant to bring their combined expertise to our 2013 AAOSH Scientific Meeting in an interactive workshop “Dental-Medical Necessity Overview” based on their 2013 book,Dentalcodelology: Diagnostic Coding and Medical Necessity.