These descriptive terms and corresponding
numbers were developed by the American Dental
Association and are used for insurance reimbursement.
Remember, these are treatment codes, not diagnostic codes.
Medicine has a similar set of treatment codes based on Current
Procedural Terminology (CPT) developed by the American
Medical Association. Both dental and medical treatment codes
are published in the Healthcare Common Procedure Coding
System (HCPCS) or "hick picks."
Diagnostic codes are routinely used in medicine, but haven't
been part of the dental insurance process until now. Medical and
dental diagnosis are combined in one set of codes, the
International Classification of Disease (ICD). More formally,
they are known as the International Statistical Classification of
Diseases and Related Health Problems. These codes are published
by the World Health Organization and used worldwide
for reimbursement now, but were originally drawn up to systematize
the gathering of morbidity and mortality statistics. The
most current set of codes is ICD-10, updated in 1992, with
ICD-11 scheduled to be completed in 2015. In the United
States ICD-9 codes are still being used, with federal regulations
suggesting adoption of ICD-10 codes by October 1, 2013.
Diagnostic codes cover diseases, signs and symptoms, abnormal
findings, complaints, social circumstances and external
causes of injury or disease. The international version includes
more than 16,000 codes. The U.S. ICD-10 codes are an
expanded version including 155,000 codes. This system allows
every health condition to be assigned a unique code.
In ICD-9, there are 10 topic areas under Diseases of the Oral
Cavity, Salivary Glands and Jaws. One of these categories is
Gingival and Periodontal Diseases, with these subcategories that
also have several subcategories each:
- Acute gingivitis
- Chronic gingivitis
- Gingival recession
- Aggressive and acute periodontitis
- Chronic periodontitis
- Periodontosis
- Accretions on teeth
- Other specified periodontal diseases
- Unspecified gingival and periodontal diseases
Here's another way to get a sense of just how many dental
diagnostic codes there are; within ICD-10, dental codes are
found in Chapter 11, Diseases of the Digestive System, and take
up 15 of that chapter's 48 pages. There are far more dental diagnostic
codes than current dental treatment codes. Medical treatment
codes correspond to ICD diagnostic codes.
With so many more conditions recognized in the diagnostic
codes, there is a need for more specific treatment codes. For
example, chronic gingivitis should have a corresponding treatment
code. However there is no dental treatment code specific
for chronic gingivitis, so many patients are treated as either
healthy with a "prophylaxis" or with treatment codes specific to
moderate to severe periodontitis. It's an example of how so many
treatments fall through cracks in the dental coding system.
Missing from the ICD codes are mention of healthy states,
except "well baby visits." Dental hygiene patients are treated preventively
to avoid caries and periodontal disease, so adding diagnostic
codes to the dental section would be helpful: caries-free
and periodontal disease-free.
To be ready when insurance companies require diagnostic
codes, start today by writing down the periodontal diagnosis for
each patient. Many of those "prophy" patients will actually be
diagnosed with disease: gingivitis or periodontitis; early, moderate
or severe; localized or generalized; acute or chronic;
supragingival deposits and/or subgingival deposits; calcified or
soft deposits; stain, etc., making the correct diagnosis essential
for determining treatment.
|