4 Reasons to Prepare Now for ICD Coding
Is your practice ready for widespread ICD-10 diagnosis coding? If not, says Grand Rapids dentist Chris Smiley, DDS, a past chairman of the ADA Council on Dental Benefit Programs and current editor of the Journal of the Michigan Dental Association, it’s time to get ready.
You know CDT codes, which identify procedures for patient record-keeping and claims submission. ICD codes designate a diagnosis, not the service provided. The letters stand for International Classification of Diseases, and these codes are promulgated by the World Health Organization. There’s a place on the standard ADA claim form and the HIPAA standard electronic claim for ICD codes, but, except for use with some state Medicaid plans, and for specific surgical procedures, they’re not required by dental payers—yet.
ICD codes’ current incarnation—the ICD-10-CM (for “clinical modification”)—is the HIPAA standard maintained by the federal government that became effective in 2015, and it was a whopping change. While the predecessor ICD-9-CM had 13,000 different codes, ICD-10-CM boasts 68,000.
“ICD-10 is extremely robust,” explains Dr. Smiley. “For example, there’s a code for ‘trauma from bite by a turtle.’ Then there’s a separate code for ‘trauma from bite by a turtle—second occurrence.’ Somebody’s extremely slow in getting out of the way of that turtle!”
Seeking data to drive decisions
But diagnosis codes can’t be laughed away. They’re part of health care’s effort to use data to become more cost-effective, and while medical doctors were affected first, that bell tolls for dentists, too. ICD-10-CM codes are likely to be required by dental payers before long, and in mastering their use you can’t afford to be turtle-slow.
“They’re coming,” says Dr. Smiley. “It behooves dentists and dental office billing staffers to become familiar with them.”
ICD-10-CM codes comprise a letter followed by two numerals, a period, then a varying number of further numerals (and sometimes letters). They can be tricky. Code K08.1, “complete loss of teeth,” for example, is followed on the list by 32 other complete-loss-of-teeth codes broken down by cause, including four classes each of trauma, periodontal disease and caries.
To make sense of all this, Dr. Smiley swears by a volume called CDT Coding Companion: Training Guide for the Dental Team published by the ADA, which can be ordered from the member service center (800.621.8099) or online at ada.org. In it, CDT codes are “cross-walked” to appropriate ICD-10-CM codes. Additionally, CDT 2020 and CDT 2021 provide pertinent instructional detail found in Section 3, “Diagnoses for Dental Diseases and Conditions.”
Your office likely already reports ICD-10-CM codes when billing medical insurers for treating conditions that bridge dentistry and general medicine. For example, for dental airway appliances used to treat sleep apnea; cone-beam/CAT scan imaging; and dental repairs needed in treating auto-accident injuries.
Samantha Hanes, business assistant supervisor at the Center for Oral Surgery and Dental Implants in Grand Rapids and Rockford, spends half her work day coding—and for oral surgery that includes ICD-10-CM. Her tip: “Make sure the doctors’ notes support the diagnosis code you choose.” To help her code diagnoses effectively—correctly identifying, say, an underlying condition that could have implications later in treatment—she relies on three tools:
- Coding software from Salt Lake City-based Optum360 (optum360.com)
- A personal crib sheet of codes that come up most often
- Coding workshops put on by the Michigan Dental Association. (The MDA doesn’t currently have such a workshop planned for the next 12 months, but that could change. For info, call the group at 517.372.9070 and ask for the Continuing Education Department.)
“All payers are different,” says Dr. Smiley. “Seemingly, some administrators just look at the submitted services and the patient and provider information to process a claim. Others may synthesize all of the information on the claim form to build a profile to assess a provider’s effectiveness, and/or measure the plan’s success at assuring access to care, utilization of services and cost containment.”
What can practices do to prepare for the ICD era? For one thing, take Hanes’s hint and keep good treatment notes.
By now, most practices have invested in chairside clinical software that makes it easier to record clinical information in detail. (If you haven’t yet, Eaglesoft, Dentrix and Epic are brands to check out, says Dr. Smiley.) But whether you click or scribble, you need to document detailed diagnosis information. For instance, says Dr. Smiley: “The hygienist should record what type of periodontal disease a patient has—type 1, 2 or 3—when care is provided to treat those conditions. Clinical notes should build a history there from past encounters with the patient to support treatment decisions.”
No one’s suggesting you deputize a staffer to memorize the 68,000 ICD-10-CM codes. “But he or she should know where to find them,” suggests Dr. Smiley. Again, a great resource is CDT manual Section 3, which presents a subset of some 750 ICD codes that are likely to be most relevant to the patient conditions encountered by dentists in practice.
How ICD codes can help you
It’s not clear when payers will begin requiring dentists to enter ICD-10-CM codes—it may depend on what new health reform legislation follows the election. But there are four reasons it could be smart to use these codes starting today:
- They could reduce the need to file an appeal should a payer come back to you on a claim asking for information about why a service was needed.
- They could protect you by documenting patients’ status. A 2013 journal article noted that such coding “could potentially provide private practitioners with beneficial information about the overall health status of patients in their practice.” For example: Suppose a payer’s data shows that your fillings fail at a higher-than-average rate. Information that ICD-10-CM codes provide could prove that those patients have a greater level of risk or rate of decay.
- They could garner some patients an enhanced level of benefits. For patients with specific medical diagnoses, some dental plans provide added benefits. For example, they may cover additional cleanings and periodontal services for expectant mothers and patients with diabetes. Reporting an appropriate diagnosis code will allow for more complete documentation of your patients.
- They’re the future. Reporting ICD codes may well be a way to reduce the need for claim attachments and supporting narratives, making the submission process more efficient. Says Dr. Smiley: “A dental office is going to be able to better serve the future needs of its patients (and get paid doing it) if it knows how to appropriately apply diagnosis coding with their claims submissions. The time to learn is now!”