Failing to use accurate CDT codes in documentation will cause payment delays and denials and also increase fraud risk. Here are some best practices from the Academy of General Dentistry (AGD) to ensure effective coding and accurate claim submission, and reduce risk of denials and allegations of fraud:
- Use the most precise and up-to-date code to reflect the procedure performed. The CDT Code that is valid on the date of service should be reported.
- Submit supporting documentation such as narratives and radiographs. Diagnostic radiographs must have the patient’s name and the date on which they were taken. Claims for teeth treated with crowns or on lays must include periapical images. Periodontal treatment determinations generally require charting and radiographs. Narratives should be clear and concise, and state the diagnosis and reason why the procedure was performed.
- Ensure that the patient’s personal information is entered correctly – birth date, Social Security number, and insurance policy and group numbers.
- If a claim is denied for lack of dental “necessity” or “appropriateness,” even if all the required information and documentation have been submitted, file an appeal as articulated in the explanation of benefits (EOB). Language from the code’s nomenclature and/or descriptor in the CDT Code should be used to file the claim and explain why the services provided were necessary or appropriate.
With all these unique challenges, many practices are opting to hire Certified Dental coders (CDC) from the American Dental Coders Association, who stay informed about CDT, CPT, and ICD code changes and payer guidelines, an experienced dental billing specialist is more apt to submit error-free claims and ensure optimal reimbursement. Obtain your CDC certification today at the American Dental Coders Association
