Diagnostic Coding for Dental EHRs: Obtaining Reimbursement

To obtain reimbursement from insurance companies for some procedures, diagnostic codes are necessary. TMJ treatment is one condition that ICD-10 codes are needed, and the claims forms need to be correctly filled out. As the understanding of periodontal disease and its interaction with conditions like pregnancy and diabetes continue to grow, some insurers also cover extra preventative cleanings. However, even where this is covered, the dentist must correctly fill out the diagnostic code in the claim for reimbursement.

In the following video, Mark Jurkovich discusses the current state of diagnostic coding for dentists, including tools to assist dentists in navigating the codes. One link he discusses is a searchable ICD-10 database, available here. In this discussion with Mike Uretz, Mark Jurkovich provides an in-depth introduction and context for dental diagnostic coding.

In discussing whether or not diagnostic codes are going to saturate dental software, Mark refers to the Minnesota mandate as well as the many competitive and interoperability reasons that diagnostic codes can benefit and improve a dental practice:

“Even though there’s a mandate, and there aren’t any penalties, understand that it’s a state law [in Minnesota]. It’s going to be very difficult for our Board of Dentistry to look beyond the fact that it’s a state law. So I think it’s going to be necessary for you to move in this direction, regardless of whether you want to or not. It’s kind of the next step. But there’s also a tremendous number of competitive reasons to do so. The systems are going there very rapidly, the marketplace is looking at this rapidly. I think you would find them [codes] to be very, very beneficial–not because you have to use it, but because they’re good for you and your patients.”

Lessons Learned:

  • Risk assessments for caries will be standardized ratings, guided by the ADA.
  • ICD-10 codes are often necessary for covered extra preventative cleanings, as well as TMJ and some other specialized procedures. Dentists need to know how to enter these codes on claims for reimbursement.
  • SNODENT is an international dental diagnostic code set, more details available at the ADA. SNODENT is part of SNOMED-CT, which means it can be used to testify for meaningful use.
  • Standardized terminologies like these are critical for interoperability, data exchange and portable health records.