Opioids including prescription drugs, heroin, and fentanyl killed more than 42,000 people in 2016, more than any year on record, according to the ADA. The opioid crisis has been called a public health emergency. Our Current Dental Terminology (CDT) codes can help make a difference.
The Centers for Disease Control and Prevention (CDC) reports that 40% percent of these opioid deaths involved a prescription pain reliever. The ADA recently passed an interim policy on opioids supporting:
- Mandatory continuing education on prescribing opioids and other controlled substances.
- Prescribing limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with the CDC’s evidence-based guidelines.
- Dentists registering with and utilizing prescription drug monitoring programs to promote the appropriate use of opioids and deter misuse and abuse.
Another Level for Ohio
Ohio exceeds the ADA’s new policy with its limits on prescription opioids for acute pain. Dentists in Ohio are required adhere to their Board of Pharmacy rules for what constitutes a valid prescription. What makes this different is the requirement for controlled substances to include a diagnosis code effective for all opioid prescriptions by December 29, 2017, and all other controlled substances by June 1, 2018.
Dentistry has yet to implement the nationwide use of diagnosis codes. This prompts the question of how a dentist can comply.
Using CDT Codes on Rx
CDT is identified as the standard code set for dentistry. The purpose of the CDT Code is to achieve uniformity, consistency, and specificity in accurately documenting dental treatment.
Codes are important for more than submitting for third-party reimbursement. Federal HIPAA law requires the use of CDT codes in electronic healthcare transactions. Using CDT codes to stem the opioid tide makes sense.
How to use CDT codes for this purpose takes some explanation and adds to recordkeeping requirements in a new way. There are no CDT codes for writing prescriptions. The CDT code required for this purpose is the treatment code. For example, a prescription for opioids is written after.
- D7410 extraction, erupted tooth or exposed root
- D9110 palliative (emergency) treatment of dental pain
- D3310 endodontic therapy, anterior tooth
Only the number portion is required on the prescription. What is important to note is that the CDT codes listed above include “D” at the beginning to denote them as CDT codes. The prescription (see the figure) shows where a CDT code is needed for prescribing dentists.
Diagnosis Code Use Now
As already noted, at this time, dentistry is not required to use diagnosis codes. Smart practices are already doing so. This is not limited to medical cross-coding. Both ADA claim forms and HIPAA standard electronic claim transactions are able to report up to four diagnosis codes per dental procedure in Box 34 A.
This information may affect how a claim is paid when specific dental procedures minimize the risk associated with the patient’s oral and systemic health condition.
Dentists and all clinicians must become more involved in coding. Most often, coding is left to the business professionals in our practices. In a fast, moving, changing world, this can no longer be the case.
Dentists by virtue of their clinical education, experience, and professional ethics are responsible for the diagnosis. As such, the dentist is also obligated to select the appropriate diagnosis for patient record and claim submission—and now in the case of prescriptions in Ohio.
This does not leave dental hygienists off the hook for their role in the diagnostic process. The dental hygiene diagnosis as defined by the ADHA is the identification of an individual’s health behaviors, attitudes, and oral healthcare needs for which a dental hygienist is educationally qualified and licensed to provide.
The dental hygiene diagnosis requires evidence-based critical analysis and interpretation of assessments to reach conclusions about the patient’s dental hygiene treatment needs. The dental hygiene diagnosis provides the basis for the dental hygiene care plan. It is part of the complete dental diagnosis and treatment planning.
Coding, fees, and coverage are all mixed up together in our thinking. Coding is separate and must be thought of this way. DentalCodeology is a word I’ve coined. It means the study of dental codes. Accurate coding has never been more important as it is now and will be in the future. Dental codes can save lives.
Ms. DiGangi believes dentistry is no longer just about fixing teeth. Dentistry is oral medicine. Her work helps dental professionals embrace the opportunities and understand the metrics that accurate insurance coding provides. In fact, the ADA recognized her expertise by inviting her to write a chapter in its CDT 2017 and 2018 Companion books. Patti holds publishing and speaking licenses with the ADA for Current Dental Terminology, 2018 as well as SNODENT, 2018 diagnostic coding. She is the author of DentalCodeology, which is a series of easy-to-read, bite-sized books. Her latest brand extension, The Dental Codeologist Community, was launched in August 2017. Dental Codeologists have a voice and choose to shape the future of coding and healthcare. She can be reached at DentalCodeology.com.