Teresa Duncan dental

Coding Coach's Corner: The hygienist’s role in dental insurance coding

June 13, 2013
Coach hears many questions regarding dental coding

This month I had the opportunity to talk with Patti DiGangi, RDH, BS, about her new book, Dentalcodeology. The book is written for the clinical team (specifically hygienists) on the typically administrative topic of dental insurance. Patti has long been an advocate for electronic dental records and the role that proper documentation plays in its implementation.

Q: Hygienists traditionally don’t handle insurance. Why do you think it’s important for them to know and understand codes?
Electronic health records (EHR) offer a myriad of potential benefits by sharing patient’s clinical information. Dentistry will need to move to a diagnostic-centered care model to be interoperable with the rest of health care. Coding is at the forefront of this process. Clinical professionals can no longer be hands-off with coding concerns. Making and recording risk assessment and diagnosis is part of CDT coding, an often ignored part.

Q: Which code do you think is the most misunderstood from a hygienist’s point of view?
The questions that I identified in my book as “eternal questions” are ones I’ve been asked over and over, and they include:

· Why are there no codes for care for active gingival disease without bone loss?
· Can you code panoramic and bitewing images as a full mouth series?
· What if Dominic (one of the six case studies) is age 13 with an adult dentition? Should it be coded D1110 or D1120?
· What is the code for using a laser for Kelly?
· Can D4341/2 and D1110 be used on the same day?
· Can Kelly ever go back to D1110?

And the most eternal of eternal questions — The insurance carrier said to alternate D1110 and D4910. Is this correct? Read more here.

Q: What trends would you advise a hygienist to watch for with regards to insurance coding?
A hygienist should learn CDT now and begin to better document risk assessment and diagnosis. No one knows risk better than insurance carriers. In CDT for 2011-2012, ADA versions of CAMBRA Caries Risk Assessment forms were included. In April 2013, Delta Dental began offering PreVisers’s myDentalScore.com to its 60 million subscribers. Risk assessment can only be completed by the clinical staff, and it is happening. The sooner clinical professionals begin this process, the easier the transition will be to interoperable electronic health records. Even paperless offices are not ready for this part.

Q: What has the feedback been like for your new book?
A: The book was released on April 4 of this year, and the first printing sold out before the end of April. Some people who bought one copy bought a second and third copy for others in the office. It has a unique 3 x 5 size so that it fits easily into the pocket of a scrub, and it is already formatted as an eBook.

You can order Patti’s book at www.dentalcodeology.com.

PAST ARTICLES BY TERESA DUNCAN:Coach’s Corner for Dental Coding
When to use primary and secondary insurance

Teresa Duncan, MS, FADIA, FAADOM, is an international speaker who addresses topics such as insurance coding, office manager training, and revenue growth. Her company, Odyssey Management, Inc., provides virtual, customized training in these areas. She can be reached at [email protected].