The Importance of CDT Codes
The CDT codes are important to describe procedures in claims (“Code on Dental Procedures and Nomenclature (CDT Code)”). However, Patti DiGangi, “a certified Health Information Technology trainer,” says “The existence of a code does not mean a patient has coverage under a policy. Yet without a code, no coverage can be offered. This is where the confusion lies. Codes and coverage are related but are not the same. It is the obligation of the practice to use the code that most accurately describes the procedure” (2015). When there are no codes for a procedure, the clinic must describe it (“Frequent General Questions Regarding Dental Procedure Codes”). Fortunately, the ADA (American Dental Association) amends the codes every year in order to account for the changes and developments of dental procedures, taking “requests for additions and revisions” from people and organizations, such as dentists, “the ADA’s Council on Dental Benefit Programs, dental specialty organizations, third-party payers, and others in the dental community” (“Frequent General Questions Regarding Dental Procedure Codes”). The clinics’ staff must write the correct and accurate codes on claims for insurance companies in order to avoid fraud.
Clinics must train their staff members about the CDT codes and their updates. According to Ann-Marie C. DePalma, “a Fellow of the American Academy of Dental Hygiene,” and Christine Taxin, “the founder and president of Links2Success,” clinics should train many people, such as billing staff and hygienists, on these codes and their updates (DePalma 2016; Taxin 2016). By doing so, employees “can identify situations when the new codes might apply, understand when it’s necessary to gather more information on medical conditions related to a procedure, and document procedures fully so that they can be eligible for medical billing whenever possible” (Taxin 2016). An alternative to training one’s staff would be to outsource insurance to another company, whose employees would check the claims’ codes (Hatch 2017).
However, when clinics send claims with inaccurate codes, they may be convicted of fraud. Some employees commit fraud “for the purpose of gaining unauthorized benefits” (Lewis Jr. and Farragher 2013). Fraud includes using the wrong code, up-coding, which means “‘reporting a more complex and/or higher cost procedure than was actually performed,’” and “unbundling of procedures,” which means “‘the separating of a dental procedure into component parts with each part having a charge…” (Lewis Jr. and Farragher 2013). These reportages of inaccurate codes may lead to higher bills for the patients (Lewis Jr. and Farragher 2013). Dentists must “[run] background checks on all employees prior to hire,” closely supervise them and the clinics’ accounts, and hire “qualified certified public accountants, lawyers, trainers, and advisors” to investigate fraud (Lewis Jr. and Farragher 2013).
Many people in dental clinics must be updated on the CDT codes annually in order to use them correctly. Unfortunately, some employees may use these codes to swindle patients out of their money. Dentists need to make sure that their employees use the CDT codes correctly.
“Code on Dental Procedures and Nomenclature (CDT Code).” ADA American Dental
Association. Accessed August 24, 2017. http://www.ada.org/en/publications/cdt.
DePalma, Ann-Marie C. “Fear of codes? Seminar by Kathy Forbes prepares the hygienist for
using the correct insurance codes.” RDH, August 23, 2016. http://www.rdhmag.com/articles/print/volume-36/issue-8/contents/fear-of-codes.html.
DiGangi, Patti. “Dental coding truths and myths.” DentistryiQ, February 12, 2015.
“Frequent General Questions Regarding Dental Procedure Codes.” ADA Center for Professional
Success. Accessed August 24, 2017. http://success.ada.org/en/dental-benefits/frequently-asked-questions-regarding-dental-codes.
Hatch, Laura. “Insurance outsourcing: Is it right for your dental office?” DentistryiQ, May 17,
Lewis Jr., Donald P. and George P. Farragher. “Dental health-care fraud and abuse.” Dental
Economics, December 19, 2013. http://www.dentaleconomics.com/articles/print/volume-103/issue-12/features/dental-health-care-fraud-and-abuse.html.
Taxin, Christine. “Medical billing for dental offices and the 2017 CDT updates: What you need
to know.” DentistryiQ, September 22, 2016. http://www.dentistryiq.com/articles/2016/09/medical-billing-for-dental-offices-and-the-2017-cdt-updates-what-you-need-to-know.html.