Recent Survey Looks at Dental Diagnostic Coding

Most dental providers are familiar with diagnostic coding for insurance billing purposes. A recent survey study shows that dentists are increasingly aware of the role coding plays in improved quality of care.

The National Network for Oral Health Access (NNOHA), in conjunction with the National Association of Community Health Centers (NACHC) and the DentaQuest Institute, conducted an online survey targeting safety-net oral health care programs (those providing dental services to Medicaid patients and the uninsured). The questions, addressing diagnostic code use, EDR systems, purposes of codes used, and code user roles in the office, were designed to identify early adapters and best practices of code use in oral health settings. Follow-up focus groups indicated that in addition to billing, coding is used for electronic health exchange, meaningful use, grant writing, improving quality of care, developing evidence-based best practices utilizing clinical decision support, and public health population monitoring.

The key leaders of any coding team are the office manager, CEO, and IT director, with ongoing training contributing to ongoing success.

Barriers to implementation that early adapters identified in the study were a lack of ability to understand the value of coding, and a lack of commitment to its implementation. Study participants also mentioned the presence of multiple coding systems as a factor in delayed use of coding. The current International Classification of Disease (ICD-9) coding system was originally scheduled to transition to ICD-10 by October 1, 2013. This may be delayed for a year as another terminology/coding system, the Systematized Nomenclature of Dentistry (SNODENT), continues to gain popularity.

“Without a consensus and decision on which classification will be the national standard, it is difficult to completely commit resources to implementation.”

Suggestions given for those beginning to use diagnostic codes include the recommendations to invest in initial and long term training for employees at all department levels, prepare for loss of production during implementation, create timelines, and budget beyond the implementation timeframe. This is particularly relevant to group practices, where standardizing diagnostic coding can lead to overall efficiency and understanding of the patient base when multiple providers may or may not be able to communicate about diagnoses.

Lessons Learned:

  • While oral health providers are familiar with diagnostic coding use for insurance billing, they may be less familiar with the ability of coding to improve health and quality of care.
  • Multiple dental diagnostic coding systems exist, and no definitive national standard exists.
  • Initial and ongoing diagnostic code training is crucial for oral health team members at varying levels.
  • Group practices need to define and discuss diagnostic coding among providers.

National Network for Oral Health Access. (July 2012). Diagnostic codes in Health Center/Safety-Net Oral Health Programs.