Date Posted: Thursday, March 06, 2025

 

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Dental claims now require the use of ICD-10-CM codes. Several states (e.g., Arizona) have begun to mandate that diagnosis codes be reported along with dental codes on claim forms. For instance, if a patient's visit is due to an underlying medical condition, an ICD-10-CM code must be included. Additionally, government payors like BCBS Federal already require the use of diagnosis codes, and it is expected that other payors will adopt ICD-10-CM in the future. If you have specific questions about your state's requirements or need further guidance, consider checking with your state Medicaid or commercial dental plans. 

 

Remember that dental offices typically use a subset of ICD-10-CM codes related to oral health, so it need not be overwhelming for your staff.

 

K00-K14, Diseases of the oral cavity and salivary glands, are relevant sections for dental providers:

 

• K00.0 - K00.9: Disorders of tooth development and eruption
• K01.0 - K01.1: Embedded and impacted teeth
• K02.3 - K02.9: Dental caries 
• K03.0 - K03.9: Other diseases of hard tissues of teeth 
• K04.01 - K04.99: Diseases of pulp and periapical tissues 
• K05.00 - K05.6: Gingivitis and periodontal diseases 
• K06.010 - K06.9: Other disorders of gingiva and edentulous alveolar ridge 
• K08.0 - K08.9: Other disorders of teeth and supporting structures
• K09.0 - K09.9: Cysts of the oral region 
• K11.0 - K11.9: Diseases of salivary glands 
• K12.0 - K12.39: Stomatitis and related lesions 
• K13.0 - K13.79: Other diseases of lip and oral mucosa 
• K14.0 - K14.9: Diseases of the tongue

 

Remember, understanding these codes will support evidence-based benefit plans and enhance patient care management. If you need more information, ask!

 

Finding the right ICD-10-CM code for a specific condition involves a systematic process.

 

Here are some steps to guide you:

 

• Identify the Condition: First, accurately diagnose the patient's condition. Gather relevant information from the patient's medical history, physical examination, and any diagnostic tests.
• Consult the ICD-10-CM Manual: Obtain a copy of the ICD-10-CM coding manual. You can find it online or in print. The manual contains a comprehensive list of codes organized by chapters, sections, and categories.
• Navigate to the Relevant Chapter: Each chapter in the ICD-10-CM manual corresponds to a specific body system or condition. Identify the chapter that best aligns with the patient's diagnosis. For dental conditions, focus on Chapter 11 (Diseases of the Digestive System) and Chapter 12 (Diseases of the Skin and Subcutaneous Tissue).
• Locate the Specific Code: Within the relevant chapter, search for the specific condition. The codes are alphanumeric and follow a consistent format (e.g., K00.0, K01.1, K02.3). Pay attention to any subcategories or additional details provided under each code.
• Consider Laterality and Specificity: Some codes require additional specificity, such as laterality (left vs. right) or severity. Choose the most accurate code based on the available information.
• Use Additional Codes When Necessary: In some cases, you may need to use multiple codes to fully describe the patient's condition. For example, if a patient has both dental caries and gingivitis, report both relevant codes.
• Check for Excludes Notes and Code First Notes: Excludes notes indicate conditions that should not be coded together. Code first notes provide guidance on sequencing codes (e.g., underlying condition vs. manifestation).
• Document the Code: Once you've identified the appropriate code, document it in the patient's medical record and use it on claim forms for billing purposes.

 

Remember that accurate coding is essential for proper reimbursement, clinical decision-making, and statistical analysis. If you encounter any challenges or uncertainties, consult with colleagues, coding specialists, or refer to official coding guidelines.

 

Let's explore an example of finding a specific dental code using the CDT (Current Dental Terminology) system. Dental codes help accurately document and bill various dental procedures.

 

Here's how you can find a code:

 

• Identify the Procedure: Suppose a patient has an abscess of the gums, which requires incision and drainage in your office.
• Navigate the CDT Code Manual: The CDT Code is published by the American Dental Association (ADA) and is updated annually. It provides a standardized set of codes for dental procedures. Each code consists of five alphanumeric characters (e.g., D7510 ).
• Search for the Relevant Code: In the CDT manual, look for the section related to oral evaluations and surgical procedures. Find the code that corresponds to incision and drainage of abscess of the intraoral soft tissue.
• Specific Example: The dental (CDT) code for this procedure is D7510. Note that the medical (CPT) code for the same procedure is 41800, so use the code that the payor wants on the claim.

 

What ICD-10-CM Code Should I Use for Dental Care?

 

Z01.20, Encounter for dental examination and cleaning without abnormal findings, is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 

 

Why Is This Happening?

 

The oral systemic issues and all Dental has now included Enhanced Benefits for Hygiene, so patients' oral systemic issues will receive more care under the dental policy. Also, the medical world has issued a website to teach medical providers because they need to collaborate with the dental world. Now is the time we need to change our perception of treatment since it is for the overall health of the patient.

 

Each state's Medicaid and CHIP programs are continually evolving, with most states expanding coverage for low-income adults and modernizing their eligibility, enrollment, and renewal processes. These changes are often influenced by the Affordable Care Act. If you need more specific information about a particular state, ask!

 

Here's what Horizon Dental has to say about the use of ICD-10-CM codes:

 

Dental Medical Claims Require ICD-10 Codes   Your role as an active practitioner in your patients' dental care is vital to their overall health. In an effort to better care for your patients, our members, we require that you provide ICD-10 codes when submitting claims to us. ICD-10 codes capture more detailed healthcare data to help improve patient care and outcomes. You should review your patients' overall health with them at every visit and document the appropriate ICD-10 codes for any health conditions and medications that are important to the care you provide. How to submit ICD-10 codes with claims: The American Dental Association (ADA) has included a section on the 2012/2019 revised claim form for ICD-10 codes. Please submit appropriate ICD-10 codes in section 34a of the 2012/2019 ADA claim form as a routine part of submitting your claim to us. Use any and all ICD-10 codes within the following categories: Alcohol use complications: 099.33 Cardiovascular disease; screening for disease or disorder: Z13.9 Chronic kidney disease: N18.9 Diabetes: E08-E13 Drug use complicating pregnancy: F11-F16 Maternity/pregnancy Pregnancy diabetes: 024.9 Vomiting: 021.8

 

Remember that accurate coding ensures proper reimbursement and supports efficient claims processing. If you encounter any specific scenarios or need further assistance, consult the official CDT manual or seek guidance: Contact Christine Taxin at ctaxin@links2success.biz or go to www.dentalmedicalbilling.com and join their yearly membership program.

 

Christine Taxin is President of Links2Success Dental Management & Consulting Service, which provides practice management support to medical and dental practices and offers opportunities for individuals looking for Continuing Education in Dental Management to develop the necessary communication and organizational tools. Christine Taxin's presentations and webinars on practice management are packed full of concepts and systems that can be applied immediately in your business. Her seminars address the doctor and the entire team with positive and fun solutions for a productive and successful practice in today's changing economy. Visit Links2Success.biz for more information.

 

Source: Findacode

 

 

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