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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More About Medical Coding
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!