Diagnostic code changes approaching

The Centers for Medicare and Medicaid Services (CMS) has set the implementation date of the International Classification of Diseases version 10 Clinical Modification (ICD-10 CM) for Oct. 1. While the implementation of ICD-10 CM affects a limited number of dentists in California, such as oral surgeons, anesthesiologists, pathologists, etc., it is important to note that all dentists should be aware that diagnostic coding could become a requirement in the future.

The Oct. 1 deadline also impacts dentists who bill Medicaid in selected states (Nevada and Arizona only), Medicare (nationally) and those covered under the Health Insurance Portability and Accountability Act (HIPAA). Currently, neither the commercial dental plans in California nor the Denti-Cal program (California's Medicaid dental program) are requiring the use of diagnostic coding for dental claims payment.

Here's what dentists need to know.

Impact on Dentists

For some dentists, the adoption of ICD-10 may be more immediate, particularly those dentists who submit claims to medical carriers for oral and maxillofacial surgery, anesthesiology, temporomandibular disorder treatment, facial pain and sleep apnea. Oral pathologists and oral radiologists, pediatric dentists and others who may treat patients in a hospital or outpatient surgical center may also need to adopt the ICD-10. However, it is important that all dentists prepare for the possibility that reporting of ICD-10 diagnostic coding may be in their future as the codes are used as a tool to identify diseases, disorders and symptoms as well as for epidemiological tracking of illness and injury.

Diagnostic vs. Procedure Codes

As of Oct. 1, ICD-10 clinical modification codes will be the standard set of diagnostic coding, but the implementation of ICD-10 does not impact the use of dental procedure codes (i.e., current dental terminology, known as CDT codes) developed by the ADA and utilized by practices for dental treatment procedure reporting and billing. The ADA Council on Dental Benefit Programs' Code Maintenance Committee approves additions, revisions and deletions to the Code on Dental Procedures and Nomenclature annually.

Preparation is Key

How should affected dentists prepare for ICD-10? To assist providers with the ICD-10 conversion, various resources are available through the ADA and CMS, including frequently asked questions, provider-specific resources, vendor-specific resources, quick-start guides, educational videos, fact sheets and infographics.

CMS outlines five steps providers should take to ensure ICD-10 compliance:

  1. Make a plan. Obtain access to ICD-10 codes, which are available from many sources, including the CMS website at cms.gov/ICD10. If applicable, dentists should work with their electronic claims clearinghouse to determine what role the clearinghouse will play in the transition. Some providers who are not ready could benefit from contracting with a clearinghouse to submit claims on their behalf.
  2. Train staff. Dentists should train their staff on the fundamentals of ICD-10. Free training resources are available from CMS and ADA. Dentists should also identify the top diagnostic codes that may be used by their practice. Visit cms.gov/ICD10 or www.icd10data.com to verify the applicable dental codes.
  3. Update processes. Dentists should update hard copy and electronic forms (CMS 1500 forms, 2012 ADA claim forms).
  4. Talk to vendors and health plans. Call vendors (practice management software companies, health plans, electronic claims clearinghouses and third-party billing services) to confirm ICD-10 readiness in the practice's systems.
  5. Test systems and processes. Dentists should verify they can use their ICD-10 compliant systems to generate a claim, perform eligibility and benefits verification, schedule an office visit and an schedule outpatient procedure. Dentists should also explore alternative ways to submit claims to health plans if they think their systems may not be ready for ICD-10 by Oct. 1.

The ADA also has several resources available to assist members with ICD reporting and transitioning from ICD-9 to ICD-10. These can be found on the ADA website and include the following:

  • A sample claim form explaining how to report diagnostic codes on an ADA claim form.
  • Answers to frequently asked questions about ICD-10 CM.
  • ICD-10 coding examples for procedure codes.
  • The CDT 2016 Companion includes a chapter with new and revised codes that correspond to ICD-10 codes. The 2016 Companion is now available for purchase.
  • The ADA Standards Committee will be hosting a symposium titled Taking the Mystery Out of Dental Coding: A Standards Perspective on Nov. 4, 2015, immediately prior to ADA 2015 - America's Dental Meeting held in Washington, D.C. For more information, contact standards@ada.org.

For more information regarding ICD-10 implementation, visit cms.gov/ICD10 or ada.org/ICD10.

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