ICD-10 and Dentistry

Consider these points to understand the ICD-10-CM requirements for dental claims.

  • Centers for Medicare and Medicaid Services (CMS) mandated that effective October 1, 2015, all HIPAA covered entities are required to implement the ICD-10 diagnosis code set. Medicaid is a HIPAA entity, as are medical and dental clinics. This mandate has been interpreted to include Medicaid dental claims; therefore, it is anticipated that all state Medicaid plans will ultimately require diagnostic coding on dental claim forms. Some states are either already requiring diagnoses codes or have informed their providers that this will be required at a future date.
  • Health insurance purchased under the Affordable Care Act (ACA) has mandated pediatric dental benefits. These benefits are sometimes administered as embedded benefits through a medical policy. Some of these plans may allow the dentist to file claims on the 2012 ADA Dental Claim Form using dental codes. However, an ICD-10-CM diagnosis code may also be required, and claims submitted without a required diagnosis code may be rejected.
  • The 2012 ADA Dental Claim Form has a field for up to four diagnoses codes. As stated above, government ICD-10 and Dentistry claims will be the first to require diagnostic coding, but private payers are expected to adopt this requirement in the future. In fact, some Delta Dental plans notified providers that the 2012 ADA Claim Form is required as of October 1, 2015. (Note: Dates of implementation vary by plan.) While this notification does not state a requirement for using diagnoses codes, it is an indicator that this requirement is tied to ICD-10 implementation.

Three areas where you can prepare for ICD-10:

  • Verify that your software vendor has the capability of submitting ICD-10 codes.
  • Become familiar with ICD-10 codes. This will make the transition easier if you need to submit diagnoses codes in the future. 
  • Review your clinical documentation. Accurate clinical documentation is important to patient care and is essential to report a correct diagnosis code.

Diagnostic Coding for Dental Claim Submission provides guidance on submitting ICD codes on dental claim forms. Visit www.practicebooster.com to learn more!