Struggling With My Thinking

Episode 072

Over the last few weeks I have been struggling with my thoughts. So much, they have been waking me up in the middle of the night. I’m not sure if my subconscious mind is trying to tell me something or not. Listen in to episode 72 of the Business of Dentistry to find out about my struggle and see if it may sound familiar…

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I don’t know if you have this same thought so I wanted to talk through it and get your feedback. What I’ve been working through about how we think is tactical vs. strategic. I’m comfortable thinking at the tactical level, like how to fix things.

That’s part of our training: we work in microns and millimeters and procedures on everything from dentures to crowns, etc. All of our training leads us to how to do something, how to work out the step by step of a procedure. But do we get into this profession because we think like that, or does our profession train us to think like that?

The counterpoint to this way of thinking, the tactical approach, is strategic thinking: why are we doing what we are doing? And that’s the piece I struggle with the most.

For example if you go into any of the online dental forums we’re all a part of and look at the questions being asked, most of the questions are related to the tactical thought process. There are far more questions related to the tactical side of things then to the strategy. And I’m comfortable with that thought process and that way of thinking, as most of us probably are.

However I get uncomfortable when I start to think of the why, what is our purpose. I’ve noticed that is something you don’t see much of online: the strategy. Which I understand, at least for me it’s hard to make the transition from tactical to strategic.

I don’t know if you do the same thing but I struggle with what am I going to do long-term? Like what is my real long-term game plan for my practice? I’m opening up and telling you this: I have some ideas but I’m not sure I’m comfortable with the long-term view. This is something we all have to think about, we all have to think about our exit strategy and have one in place.

I haven’t played with my exit strategy enough: do I want to work part-time eventually? Do I want to go into academics part-time? Do I want to get a job with a government agency? Do I want to get out of this entirely and do some other line of work? Do I want to sell my practice? Do I want to get an associate and sell it to them? When do I want to do this? I’m 50, but do I want to do this when I’m 55 or 60?

I struggle with those answers, but I need to know them and you need to have a game plan for yourself. It’s never too early to start looking at your exit strategies. Ask yourself why you are doing what you are doing. Where are you going with it?

I challenge you to think strategically, consider your exit plan and think about your long-term plan.

After you listen to episode 72 of the Business of Dentistry chew on that concept and those questions for awhile, no pun intended! And then let me know your thoughts.

Tweetable: “It’s hard to go from thinking in millimeters to thinking in years!”

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Introduction To Medical Coding

Episode 071

Hey folks, this episode we jump into the topic of medical coding. Now, don’t go worrying… I know medical coding is a complex topic but we are only covering the basics here. We will use a specific pathology case and go over the way I would approach the International Classification of Diseases Revision 10 (ICD-10) and Current Procedural Terminology (CPT) codes. Thanks for listening to episode 71 of Business of Dentistry!

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The reason for the topic today is because I am in a few closed Facebook groups with other dental professionals and many of them have questions and a lot of interest in how medical coding is done. Personally my office uses medical coding because we do oral surgery. In fact, we use it every day.

When I was an oral surgery resident they made us code, and I hated it (at the time)! Of course now I can see the benefit in my private practice, knowing the coding and understanding how medical coding works has helped me since going into private practice.

Let’s talk about the basics of medical coding: there are two simple components, the diagnosis code and the procedural code. The diagnosis code comes from the International Classification of Diseases, better known as ICD. The latest revision is the 10th and it’s known as ICD-10. ICD’s coding will be a combination of alpha numeric numbers.

The procedural code is based on the Comprehensive Guide for Current Procedural Terminology, better known as CPT. This code is 5 numbers.

You list your diagnosis codes to support your procedural codes; a lot of medical insurances look at ICD 10 to tell the story of what is going on with the patient, that determines whether it is a covered benefit or not for that case.

Now let’s talk about a specific case I saw online.

The case was posted with a picture of a soft tissue neoplasm. I call it that because the photo showed an anterior maxilla which had attached gingiva between the anterior teeth, pinkish red and non-ulcerated). The picture was posted asking what we thought it was and what should be done.

Personally if I were submitting this I would submit my pathology as general categories: soft tissue neoplasm vs hard tissue neoplasm.

In this instance it would be soft tissue neoplasm. In the medical diagnosis code they want to break it down even further, they want to know if it is malignant, benign. I use the code of unspecified behavior because that is really what I am looking at. I’m looking at a bump on the gums of a patient, it’s soft tissue and it’s soft tissue neoplasm but I do not have a definitive diagnosis.

I know in my mind what I think may be based on clinical and historical data, but I don’t know for sure. So when I submit this case for coverage of a biopsy I submit it as a diagnosis code of neoplasm of uncertain behavior.

Then there are several categories in the ICD-10 coding book. They break it out into lip, tongue, salivary glands, even into submandibular, sublingual, etc. They have one that is a catch-all and it’s called other specified sites in the oral cavity which means gingiva, palate, gum, mucosa, cheek, alveolar, process, etc. That particular catch-all code is more in line with this specific case.

I’m highlighting my use of medical coding here because I want you to see how I use it, and how I do it in such a way that the patient can get benefits from their medical coverage if their dental won’t pick it up (or if they don’t have dental but they have medical).

So in this particular case I would use the ICD-10 and would use the code for a soft tissue neoplasm (and I use neoplasm instead of cyst or granuloma). And I would use the code for uncertain behavior in other specified sites in the oral cavity (there’s no specific code for anterior maxilla). In our example this would be D37.09, which gives information about the actual diagnosis.

To hear what CPT code I’d use and why it’s important in terms of your reimbursement listen in to episode 71. You’ll get a clearer picture of the basics when you do along with an explanation of a common form my staff created to help with coding in our office (the same one you can get by clicking on the photo above).

Feel free to email me with any questions, comments or insights you have about medical coding. Thanks for being here, I appreciate you listening to this episode of the business of dentistry!

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