As of October 1, 2015, the Department of Health and Human Services (HHS) will implement a new set of dental diagnostic codes for billing called ICD-10. These new codes will primarily affect dentists who bill medical insurance through Dentrix, but dentists should be familiar with this new requirement as ICD-10 is laying the groundwork for possible future implementation of diagnostic codes in dentistry.
In the late nineteenth century, French Physician Jacques Bertillon introduced a classification standard for the medical community to track causes of death. Quickly adopted by many countries, it eventually morphed into the International Classification of Causes of Death. In the mid-twentieth century, the responsibility of managing and revising this code set was given to the World Health Organization (WHO). At that time, the volume expanded significantly and became known as the International Statistical Classification of Diseases, Injuries and Cause of Death (ICD).
While this standard code set is used in most countries, the United States, under the jurisdiction of the National Center for Health Statistics (NCHS), implemented a Clinical Modification (CM) version in the late 1970s using the 9th revision (ICD-9-CM). Even though the World Health Organization finalized its 10th revision of the ICD code set in 1992, the U.S. chose not to adopt them for tracking morbidity until the Department of Health and Human Services (HHS) proposed that a similar Clinical Modification version go into effect on October 1, 2013. The new standard was subsequently delayed twice, with the new implementation date now firm at October 1, 2015.
The looming deadline will have the greatest impact for providers who send medical claims from Dentrix. Many medical payors are already prepared and will require the new codes on all claims after October 1. However, all customers should know that since the dental ICD-10 codes were originally proposed, the groundwork has been set for the dental community to process these codes as well.
With the changes in electronic submission standards to ANSI 5010 in 2012 along with the new ADA claim form from the same year (J430), there is now an ability to submit up to four diagnosis codes on a dental claim. In fact, there are approximately 36 dental payers to date that are in the process of testing ICD10 for situational purposes. Outside of these situational requirements, we are not aware of any dental payers requiring diagnosis on all claims, however, there is a likelihood that these codes could be a requirement in the dental community in the future.
For more information, see a recent eNewsletter article about ICD-10.
Dentrix customers running version G6 can download an update that will allow for ICD-9-CM, ICD-10-CM, and SNODENT codes to be linked to an ADA code. In addition, the same medical cross-coding capabilities in previous Dentrix versions will continue to be available, but Dentrix will now allow you to map to both the ICD-9-CM and ICD-10-CM code sets.
For those of you who are submitting medical claims today or need to submit ICD-10 codes on dental claims, please contact our support team to request your update at 1.800.DENTRIX. If you are not currently running Dentrix G6, please request it here.
We are monitoring the dental payor landscape to ensure that our customers are aware of any payors testing or moving in the direction of diagnostic-driven billing. Below is a current list of payors requiring ICD-10 codes for dental procedures:
|Payer Name||Payer ID|
|Carefirst of Maryland, Inc.||00580|
|Central States Health & Welfare Funds||36215|
|Deseret Mutual Benefit Administrators||CX089|
|E.S. BEVERIDGE & ASSOCIATES||34108|
|Florida Combined Life||CBFLU|
|Group Health Coop (Indidivual & Family, and Small Business Groups)||89070|
|Hawaii Medical Service Association (HMSA)||HMSA1|
|LA BCBS AdvantagePlus Network||53021|
|LifeWise Healthplan of Oregon||93093|
|PacificSource Health Plans||93029|
|Scion Gateway Health Plan||96938|
|TR Paul Inc.||37230|
|The Loomis Company - TPA Wyomissing, PA (IHS Gateway Payer)||23223|
|United Concordia - Fee for Service||CX007|
|United Concordia Dental Plus||CX013|
|Valley Baptist Health Plan||89070|
|BCBS of Western NY||CBNYW|
|Blue Cross Blue Sheild Delaware Fully - Insured Dental Group Business||53287|
|Blue Cross of Alaska and Washington||47570|
|Blue Cross of Alaska and Washington||47570|
|Blue Cross of Massachusetts||CBMA1|