Dentalcodeology Cover Fo

DentalCodeology: medical necessity

Aug. 16, 2013
With the move toward electronic health records in dentistry, Patti DiGangi, RDH, MS, explains that the dental team—including hygienists—must provide consistent, methodical documentation of medical necessity for coding. DiGangi says codes are the language of electronic health records.
The oral-systemic link has been well-documented. Cross-discipline and inter-professional collaboration with medical care providers can improve outcomes for patients. Yet, for the most part, dental professionals still practice in separate dental silos.(1) Interoperable electronic health records (EHR), can break down these silos.
The question: "When will dentistry be required to use EHR?" was answered on 7/25/13 in Minnesota.(2-4) It is the first state to require dentists, oral surgeons, and orthodontists to adopt a certified, interoperable EHR system by 2015, like their medical counterparts. EHR is not an automated version of the paper record. An analogy can be made to smart phones. They are very different than lower-end phones and almost completely unlike old-style home phones. Smart phones give us more possibilities, so will interoperable EHR. Smart phones are interoperable meaning there is an electronic architecture behind the scenes that allows a Samsung on the Verizon system to be able to communicate with an iPhone on AT&T. So it will be with hospitals, medical offices, pharmacy and more to communicate with dental records.

Diagnostic codes are a key to EHR interoperability. Diagnostic codes are used to group and identify diseases, disorders, symptoms and medical signs. The ADA Dental Claim Form [2012 © American Dental Association](5) already reflects this direction by adding a field for diagnostic codes. Selecting the correct codes should be based on medical necessity. Medical necessity is not commonly documented in dentistry and won’t be a choice with EHR.

Medical necessity is the reason why a test, a procedure or an instruction is performed.(6) Medical necessity is different from person to person and changes as the individual changes. The team, including hygienists, must provide consistent methodical documentation of medical necessity for coding. Coding is not limited to codes for insurance. Codes are the language of EHR.

Transitioning to EHR won’t be worth the effort if there is no improvement, enhancement or value gained by all stakeholders particularly the patients. EHR will not make inadequate recordkeeping magically become useful. Waiting until your state mandates EHR makes little sense; now is the time to get started in this brave new world. Embracing concepts like medical necessity prepares the way to break down the silos.

1. DiGangi, P. (2012) Breaking Down the Silos with Electronic Health Records. The Richmond Institute. Last accessed 7/31/13:
2. Minnesota Department of Health (MDH) (2013) Guidance for Understanding the Minnesota 2015 Interoperable EHR Mandate. Last Accessed 6/11/2013:
3. Uretz, M. (2013) Minnesota’s EHR Mandate for Dentists – A Trend? DentalSoftwareAdvisor. Last Accessed 7/30/13:
4. EHR Intelligence. (7/25/13) Minnesota mandates certified EHRs for all dentists by 2015. Last Accessed 7/30/13.
5. American Dental Assocation (2012). ADA Dental Claim Form. Last Accessed 7/4/13.
6. DiGangi, P. (2013) DentalCodeology: More than Pocket Change. P. 10. Last accessed: 7/31/13.

Patti DiGangi’s book, DentalCodeology: More than Pocket Change, is designed to guide dental clinicians into the coding and interoperable electronic health records world. DentalCodeology: Diagnostic Coding and Medical Necessity will be available for purchase in fall 2013. ( To read more about Patti DiGangi, click here. To read more about coding and dental hygiene, click here.