Understanding coding

March 1, 2009
The CDT — Current Dental Terminology — is the “bible” for dental insurance.

by Ann–Marie C. DePalma, RDH, MEd, FAADH
[email protected]

The CDT — Current Dental Terminology — is the “bible” for dental insurance. As dental hygienists, although we are clinically oriented, we need to know and understand CDT and what it means to patients and our practices. Teresa Duncan, MS, presents several programs on coding and insurance and how to make it all work for you. She also presents a program on the latest products and trends within dentistry, including the use of social media, such as Facebook, to promote your practice.

Her programs on insurance coding are important for all team members. Many hygienists and assistants make entries and treatment plans directly in the operatory. If the dental professional does not understand the use and appropriateness of codes, then billing errors and lost production can occur. In today's economy, practices cannot afford to lose any opportunities for benefits and coverage. Teresa's programs review coding basics, along with common coding errors and how to avoid them. She also discusses the importance of diagnostic billing, in addition to the service billing model that most practices use.

Dentistry needs to embrace more of a medical model for conditions and risk factors in the disease process. In her programs, Teresa recommends that all treatment notes include a diagnosis as dentistry moves to adopt the medical model. Dentistry is subject to the electronic health records (EHR) law, but most practices are not even familiar with the law or its implications.

During her insurance coding programs for hygienists, the most common question Teresa receives is, “I know that I am coding 4910 wrong, but when do I use it?” Teresa discusses the importance of the correct code and how it can directly affect the hygiene department. Coming from an administrator's point of view, she knows how not having enough clinical documentation can keep a claim from being processed correctly and payment being received. Since she is not a hygienist, she feels comfortable asking clinical questions when she is unfamiliar with a patient's treatment or clinical issue. This helps in the communication process between the financial and clinical arenas within the practice, something she feels strongly about.

Teresa incorporates all of this in an entertaining, interactive workshop. She enjoys presenting small workshops, since often discussions ensue about procedures and topics to which many participants usually are not exposed. Her programs include PowerPoint and handouts containing common coding mistakes. She also presents specific programs on implant coding and has a list of implant codes with corresponding medical codes. She encourages participants to laminate handouts to keep in their operatories for easy reference.

Teresa has a master's of science in health care management from Marymount University. About 15 years ago, she was trained in dental insurance by a former co–worker who knew nearly nothing about the whole process. This instilled in Teresa the desire to learn more. Through research and attending programs, Teresa developed her own programs. She is employed in a practice that places and restores implants, so she is well versed in the importance of achieving the most benefit for patients. These are skills she tries to instill in her course participants. Teresa is the author of The Dental Implant Blog, which features a variety of topics on various aspects of working and managing a dental practice. She is a Fellow and educator of the Association of Dental Implant Auxiliaries, a component of the International Congress of Oral Implantologists. She lives in Virginia with her family, and says when you really want an honest opinion, ask an 8–year–old! Her son is her biggest fan and critic!

Whether it is from the reimbursement perspective of a general practice or a specialty office, Teresa will promote and encourage you to learn more about what CDT means to you as a hygienist. Hygienists are the clinical experts, but they also need to understand how compensation for clinical care works. We do not treat the insurance company, but the patient. We must be able to explain to patients what it all means. For more information about Teresa and her programs, contact [email protected], (703) 201–1845, or www.TheDentalImplantBlog.com.