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Cross Coding

April 1, 2010
“There are risks and costs to a program of action. But they are far less than the long-range risks and costs of comfortable inaction.”

A new way to increase your value

by Marianne Harper

“There are risks and costs to a program of action. But they are far less than the long-range risks and costs of comfortable inaction.” This quote by President John F. Kennedy speaks volumes to me. “Comfortable inaction” is a description of how so many people lead their lives. I firmly believe one’s life can be improved by exchanging “comfortable” for the work and risk-taking required to step outside the box and make a difference. Making that difference can often change and improve the lives of others.

Dentistry, as it has evolved over the last decade and continues to evolve, provides a wonderful opportunity to make just such a difference. Dentists and their staff likely have more frequent contact with their patients than do the patients’ physicians. We in the dental field are:

  • Directly impacting the overall health of our patients.
  • Learning to look at more than just the mouth when we treat our patients.
  • Learning about the signs and symptoms that are pointers to systemic disease.
  • Becoming more proactive in referring these patients to their primary care doctors when we suspect a medical problem.

We are also learning about the procedures that fall within the dental scope of practice that are considered to be medically necessary. Examples of such procedures are:

  • TMD procedures
  • Sleep apnea appliances
  • Dental trauma procedures
  • Oral cancer screening
  • Dental procedures necessary because a medical condition or treatment has compromised the patient medically
  • Medically necessary oral surgical and periodontal procedures
  • Any exams and radiographs that are needed for any of these medically necessary procedures

More oral health-care providers are performing these procedures without realizing that they can help patients better afford these treatments by filing with medical plans. Patients will be more inclined to accept treatment when they know this can be done. Dental-medical cross coding is the answer to helping our patients afford these medically necessary procedures.

You may now have two questions:

  1. Why would a hygienist be involved in dental-medical cross coding?
  2. How can a hygienist learn to do this?

Hygienists probably have more one-on-one patient contact than any other member of the team. You are probably the one with the best chance to ask the right questions or spot the signs and symptoms that may indicate a systemic problem. You can evaluate your patients’ medical history forms to be sure they are thorough.

A health history tells us more than what dental and dental hygiene procedures must be avoided. When you suspect your patient has a medical problem, you alert the dentist about your suspicions so he or she can decide if there is a dental solution, or if the patient should see the primary care physician. Many courses and articles provide such information, as well as online sites such as PreViser, Florida Probe, and PubMed.

Hygienists will need to combine what they have learned regarding indicators of systemic disease with the knowledge of what dental procedures fall within the dental scope of practice so they can alert their dentists regarding treatment. For instance, a patient who has had radiation to the head or neck will have dental needs that come directly as a consequence of that treatment. The crown or flipper or bridge for that patient can be billed to medical insurance. The hygienist is often the spearhead of that process.

This is the first step in starting dental-medical cross coding. There can be no medical claim filing until the treatment plan has been completed.

Hygienists who realize the benefits of leading the office in this way may wonder how to fully implement this system in their offices. This is the answer to the second question. If no one in the practice knows how to file a medical claim, it may be up to the hygienist to lead the practice in this learning process. There are two approaches to this task, and one is much more difficult than the other. The difficult way is to teach yourself, which is the way I started.

My experience with cross coding

About 10 years ago, when I was an office manager in a pediatric dental practice, we treated a child who had been involved in an accident. I filed with the child’s dental plan and received a response that created a major paradigm shift in my career. The dental plan informed me that they would not pay until I had filed with the medical carrier. I had no idea how to do that and wondered how I would ever be able to obtain benefits for the patient.

My first course of action was to contact a coding expert who, thankfully, completed the form for me. When a similar situation presented itself again, I tried to copy the claim that I had filed for the previous patient but found that the procedures were not identical. Had I known then what I know now, I would have realized that it is a bad decision to copy claims, as the diagnoses are probably different, which results in the need for different diagnosis codes.

I bought a dental-medical coding manual to help me understand the process and realized that medical insurance filing is quite a bit different than dental. I was successful with that claim. At that time, dental-medical cross coding was a new concept and the manual I had purchased advised filing for procedures that did not always appear to be medically necessary. This made me realize I needed hands-on training to be sure I could file correctly.

I took a part-time job at a local medical practice in their insurance coding department. Even though I worked intimately with the information, I felt that there was still a lot more I needed to learn. I studied numerous medical coding textbooks, and enrolled in a medical terminology class and a medical billing and coding class. Once I felt prepared to create medical claims I still wasn’t sure how to cross code from dental to medical.

My answer to this problem was to create a document where I cross coded our CDT dental codes with the CPT codes (medical procedure codes). I then created a list of all the diagnosis codes that could apply to the CPT codes. I named the document, “CrossWalking – A Guide Through the CrossWalk of Dental to Medical Coding.” I was finally prepared to process dental-medical cross coded claims and to teach the process as well.

Is that how you want to learn medical coding? I doubt it. There are now more opportunities to learn this process. As a hygienist, you can be the champion for your patients and practice. Who would know better what a hygienist does and why than a hygienist? It’s been my experience that the percentage of procedures that can be cross coded daily depends directly upon the procedure mix of the practice and the practice’s efficiency in implementing a cross coding system. That’s hardly a full time job at this point. With the economy making everyone nervous about job security, this is one more way for a hygienist to secure his or her position or create an entirely new expertise. And hygienists can handle this kind of billing for more than one office.

My manual is one way to learn how to implement a dental-medical cross coding system while also providing the medical codes that dental practices need to file these claims. I also offer a CD of my medical coding lecture for learning in the office or the comfort of your home. There are other courses available online. Once you have studied a medical coding manual or taken a course, you can do more than spearhead the process — you can direct it.

A positive side effect to spearheading this process in your practice is that hygienists who actively question and observe patients are helping to protect their practices. We are hearing more about patients who accuse their dentists of negligence with regard to failure to render care. You can have a direct impact on preventing such legal action.

Additionally, medical carriers are slow to accept the medical nature of many of our dental procedures. Only by the repeated filing of such claims can we change this. You can be an important part of that change.

As you can see, what I have suggested is definitely out of the box. I encourage hygienists to seriously consider whether you prefer to stay comfortably inactive in your boxes or whether you might be more content to step out and make a difference. Learning cross coding can only be a win-win experience.

Marianne Harper is the owner of The Art of Practice Management. Her areas of expertise are revenue and collection systems, front-desk systems, and dental-medical cross-coding training. Marianne is a well respected speaker, has been published in numerous dental journals, and is the author of “CrossWalking-A Guide Through the CrossWalk of Dental to Medical Coding” and “Abra-Code-Dabra - How to Easily Transform Dental Codes To Medical Codes for Non-Surgical Sleep Apnea Procedures.” Marianne is a member of The Academy of Dental Management Consultants (ADMC) the Speaking Consulting Network (SCN) and CareerFusion. Her Web site is

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