Where Can I Learn More About Billing and Coding

The world of Current Dental Terminology, or CDT, can be overwhelming at first glance. Developed by the American Dental Association (ADA), CDT is a system for classifying dental procedures/services for reimbursement by third-party payers. Getting the hang of using the correct code for specific procedures may seem daunting, but, in reality, it just takes practice and continued learning on the topic. Below you will find some common questions regarding coding with answers from Dimensions of Dental Hygiene’s resident expert on all things billing and coding: Karen Davis, RDH, BSDH.

I would love to know more about insurance billing and coding, where can I find more information/training?

For dental hygienists, one of the best places to gain better understanding of how/when to maximize ADA insurance coding based on procedures performed is beyondoralhealth.com. Patti DiGangi, RDH, is the CEO and Patti Beeson, RDH, is the executive director of this valuable resource for clinicians. Visit the website to find numerous learning opportunities. I would start by viewing the books online to fit your specific areas of interest. The books are short, easy to read, and will answer most all of your coding questions.

Thank you for your information on insurance coding, as it is a very complex world. When coding periodic, comprehensive, or periodontal exams that occur in conjunction with the dental hygiene visit, should these be billed under the practice owner’s name regardless of whether he actually completed the exam or is even in the office? 

I am glad you asked this question as I believe other practices may also be doing this incorrect coding. All diagnostic examination codes require that the dentist perform the patient examination. The dentist may delegate collection and recording of the data to an auxiliary, but diagnosis is the responsibility of the dentist. This is stated in the American Dental Association’s CDT: ada.org/en/publications/cdt/ as well as Dr. Charles Blair’s Coding With Confidence: ada.org/en/publications/ada-dental-product-guide/ You may wish to purchase one of these resources for clear direction in your practice. Thank you for asking!

During a working interview, the office manager asked how confident I am with treatment planning. I told her that would not be an issue, although I have no idea what she was asking me. I am confident with assessing periodontal health status but not so confident with determining other findings, such as restorative needs. Any tips you can give me about treatment planning? 

All dental hygienists should be confident in assessing oral conditions and composing a dental hygiene treatment plan. In some cases, this will involve interventions to reduce caries risk and initiate remineralization following accurate caries management by risk assessment (CAMBRA) documentation. In other cases, it will consist of identifying periodontal diseases and proposing customized treatment recommendations consisting of therapeutic treatment and risk factor reduction. In other cases, treatment planning may involve patient consultation and diagnosis with the dentist for restorative, esthetic, orthodontic, or endodontic recommendations. Often collaboration between the dental hygienist and dentist yields the most comprehensive treatment plans for patients with multiple needs and desires.

My own personal commitment is to “build on healthy foundations,” so naturally establishing a healthy periodontal foundation is paramount to supporting beautiful, esthetic dentistry. Feel free to share your own philosophy in patient care during your interview.