Why dental hygienists are essential for codiscovery and medical billing in dentistry

Dental hygienists are emerging as pivotal players in bridging the gap between clinical practice and medical billing. Their role extends beyond traditional duties and encompasses a comprehensive approach that supports both the dental practice and the patient's overall health.

Here I’ll delve into the crucial contributions of dental hygienists in medical billing, focusing on their role in codiscovery with dentists, and how this collaboration can significantly enhance patient care and the financial health of dental practices.

The evolving role of dental hygienists

Dental hygienists have traditionally been viewed as the backbone of preventive dental care, responsible for cleaning teeth, examining patients for signs of oral disease, and more. However, their role is rapidly expanding to include a more integrated approach to patient health that involves crucial clinical assessments and data collection that are often reimbursed by medical insurance.

Clinical data gathering and codiscovery

One of the most significant contributions of dental hygienists, like nurses in medical practices, is codiscovery with dentists. Codiscovery is a collaborative process in which the hygienist and dentist work together to assess a patient's oral and overall health. Dental hygienists are often the first to interact with patients, taking detailed medical histories and performing comprehensive evaluations. The evaluations include:

• Medical history intake: Gathering detailed patient histories to identify systemic conditions that may affect dental treatment outcomes and contribute to overall health.
• Caries risk assessment: Evaluating the risk for caries and customizing preventive strategies for the number one disease in the world.
• Maxillofacial and oral cancer screening: Using advanced screening techniques to identify cancers early, helping to save lives.
• Periodontal infection screening: Identifying infection that could lead to more severe health issues.
• TMJ disorder screening: Assessing this painful medical disorder that can impact the ability to function properly.
• Obstructive sleep apnea screening: Identifying signs of obstructive airway, which can be linked to several systemic conditions in adults and children.
• Salivary diagnostics: Using saliva tests to detect various bacteria to customize treatment.
• CT scans and full-mouth x-rays: Taking x-rays to provide a comprehensive view of the patient’s dentition, as well as the supporting bone of the maxilla and mandible, sinus, TMJ, and more.

These evaluations aid in diagnosing dental concerns and uncover underlying medical conditions that may require further attention. By teeing up the ball for the dentist, hygienists ensure a seamless transition in the codiscovery process, enhancing the accuracy and effectiveness of patient care. These types of evaluations are billable to medical insurance!

The financial impact of medical billing

Dental practices often face the challenge of writing off a significant portion of their billed charges due to insurance agreements. Typically, practices may write off 30%–40% of their charges, which can impact financial sustainability. However, by incorporating medical billing alongside traditional dental billing, practices can mitigate these losses.

Our profession has allowed the limitations of dental benefits to dictate how often we bill for evaluations, radiographs (including CT scans), emergencies, and many other procedures. Our medical specialty is the only one that writes off thousands of dollars per year because dental benefits won't or did not pay. The limitations of dental benefits are not in the best interest of patients. The limit of an average of $1,000 per year reimbursement is a coupon plan, not an insurance policy.

Bridging the gap with medical billing

Medical billing allows practices to bill for procedures that are medically necessary, which are often not covered under standard dental insurance. This includes evaluations, CT scans, panorex, lateral cephs, biopsies, frenectomies, TMJ intraoral orthotics, Botox for TMJ, cyst/abscess removal, surgical removal of impacted teeth, bone grafting, implants, surgical guides, interim/final prostheses, sleep apnea appliances, trauma, and more. In fact, the evaluations that often result in diagnosing all this treatment start with the dental hygienist.

By effectively using medical billing, dental practices can:

• Increase production: By billing medical insurance for applicable evaluations and procedures, practices can enhance their revenue streams.
• Reduce write-offs: Medical billing helps offset the losses incurred from dental insurance write-offs and you’re paid for more services that are currently written off due to frequency limitations.
• Reduce patient out-of-pocket costs: Many procedures are not covered by dental; therefore the patient incurs the cost that may be billable to medical.
• Increase case acceptance: Provides your patients with another reimbursement opportunity.
• Enhance compensation for dental hygienists: With increased revenue, practices can offer better compensation packages to their hygienists in recognition of their expanded role and contributions.

The role of dental hygienists: Advocates and catalysts for practice success

Dental hygienists play a multifaceted role in dental practices, serving as vital oral health advocates and key contributors to the practice’s financial success. Beyond their clinical and billing contributions, they’re instrumental in educating patients about the importance of oral health and its connection to overall well-being. By identifying potential health risks and advocating for comprehensive care, hygienists empower patients to take an active role in their health management.

Uniquely positioned to educate patients about the systemic links of oral health, dental hygienists use their interactions to discuss preventive measures, lifestyle changes, and treatment options. This patient education is crucial in fostering a proactive approach to health, encouraging patients to seek necessary treatments and adhere to recommended care plans.

The integral role of dental hygienists in boosting production cannot be overstated. The success of a dental practice often begins with the hygienist, who lays the foundation for comprehensive patient care and effective billing practices.

The initial patient interaction with the dental hygienist sets the tone for the entire dental visit. They conduct thorough assessments, identify potential issues, and initiate the codiscovery process. This proactive approach enhances patient care and streamlines the billing process, ensuring that all necessary procedures are documented and billed appropriately.

One significant advantage of involving dental hygienists in medical billing is the potential for higher reimbursement rates compared to traditional dental benefits. When billing medical insurance for evaluations, the reimbursement is often based on the time and complexity of the encounter. This aligns well with the comprehensive assessments performed by hygienists, which include evaluations of medical histories, systemic conditions, and various screenings. These thorough assessments lead to higher reimbursements, as they’re taken into account under medical billing criteria.

By efficiently gathering clinical data and facilitating communication between patients and dentists, hygienists enhance practice efficiency. Their ability to identify and document medically necessary procedures ensures that practices can maximize their billing potential, reducing reliance on write-offs and increasing overall production. Through these combined efforts, dental hygienists are not only advocates for patient health but also catalysts for the financial and operational success of their dental practices.

Editor's note: This article appeared in the October 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.