A Step Toward Standard Dental Diagnostic Codes

While dental procedure codes and associated terms have been a standard part of dentistry for many years using American Dental Association (ADA) Current Dental Terminology (CDT), standard dental diagnostic terminology does not exist. Standard medical diagnostic codes are maintained internationally by the World Health Organization’s International Classification of Disease (ICD), and in the United States by the Synthesized Nomenclature of Medicine Clinical Terms (SNOMED-CT). Neither of these adequately covers dental and oral diagnoses. As the authors of the article cited below explain:

“Dentistry therefore has excellent records on what procedures were actually performed on patients, but little to no standardized diagnostic terminology giving the rationale for why those procedures were done.”

A pilot project at the University of California, San Francisco, School of Dentistry, studied a locally developed dental diagnostic terminology loaded into the EHR over a 1 yr. period. A total of 147 terms were pulled from the Toronto System and ICD. Terms were grouped under the disciplines of periodontology, caries, restorative dentistry, endodontics, fixed and removable prosthodontics, oral medicine, and oral surgery.

Use of the diagnostic codes by students and faculty was strictly voluntary. An underlying purpose of the study was to train students to define a working diagnosis while planning treatment, and to associate a definitive diagnosis with procedures ordered. These diagnoses were associated with 335 unique procedures in procedure/diagnosis pairs.

A total 38.9% of procedures entered in the EHRs had an associated diagnosis. Of these, 76.7% were valid based on a correct association between the diagnostic term and the procedure code as assessed by three independent evaluators.

The project terminology has the potential to expand to other Consortium for Oral Health-Related Informatics (COHRI) dental schools, and eventually to ICD and SNOMED for incorporation into EHRs used in dental private practice.

Lessons Learned:

  • While standard codes exist for dental procedures, there is no standard for dental diagnostic terminology.
  • ICD and SNOMED do not adequately cover dental diagnostic terms.
  • Using standard diagnostic terms trains providers in evidence-based practice.

White, J. M., Kalenderian, E., Stark, P. C., Ramoni, R. L., Vaderhobli, R., & Walji, M. F. (2011). Evaluating a dental diagnostic terminology in an electronic health record. Journal of Dental Education, 75(5), 605-615.