Jun 23, 2021
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Inspired by an article in Dentistry IQ regarding a popular misconception about CPT codes, Michelle and Andrew have invited two experts in the coding field to the podcast today to set the record straight. Teresa Duncan is a speaker and writer with over 20 years experience in healthcare whose expertise includes proven accounts receivable and insurance methods, and helping doctors and managers establish solid management systems. A recipient of the Educator of the Year Award by the Association of Dental Implant Auxiliaries, Teresa is also an author and a frequent contributor to a variety of publications. She has been named one of the Top 25 Women in Dentistry by Dental Products Report Magazine, and is recognized yearly as a Leader in Consulting by Dentistry Today. Jamie Collins, RDH-EA,BS, is a clinical practicing hygienist who has been in the dental field for twenty years. In addition to clinical practice Jamie is also an educator, has contributed to multiple textbooks, curriculum development and creation, and contributes as a key opinion leader with multiple companies. She is an active member of the American Dental Hygienists Association, a member of the Dental Codeology Consortium Committee for dental coding, and a colleague of Michelle’s at MouthWatch.
In today’s episode, our hosts and guests discuss CDT codes in general, where dentistry has gone wrong in coding, the ADA and carriers, and the new staging and grading and which codes may apply there. They also delve into diagnosis coding, internal/unspecified codes and tracking, outcomes based payments, code 4346 and 4355 usage, the importance of educating consumers, and some code suggestions from our experts for particular scenarios. They finish up by looking at developments in coding, our experts’ takeaways for listeners, and the issue with assigning codes to products.
Interview starts: 4:32
“There's so many offices that code for what they think that they're going to get reimbursed for, rather than coding for the procedures that are actually performed.”
“Dental offices don't want to lose patients, they still want the revenue so they're going to kind of give the customer what they want.”
“I think there are times that the ADA could have been a little bit stronger in their representation against the carriers.”
“You can't worry about the insurance, you just have to treat, diagnose treatment.”
“Here's the thing with insurance carriers is when a guideline gets put out, it usually takes them about a year or two to catch up to that.”
“They're going to look at redoing the CDT completely.”
“We don't have the data in order to sufficiently say, ‘Hey, I need more money for this because I do a lot of it and it saves you money on this down the road.’”
“If we’re going to perio chart, we chart it all.”
“Are there guidelines for 4355 of how much crap we knock off people's teeth?”
“You don't go into a doctor's office and dictate that they take out this tumor or not this tumor, you don't do that. So I just think we're very scared of patients, and I just don't get it.”
“There's this thought, ‘well, it's not going to get paid, we really shouldn't even bill it.’”
“I like to get paid for things.”
“The more you bill for it, you create that metric, they're seeing it coming down the road, the more apt they're going to be to cover it.”
“I really believe that clinicians should not be aware of a patient's insurance status when they're back there.”
“Just because it's a benefit doesn't mean that it's rooted in any kind of science.”
“Start saying you probably won't get paid for it, but you can do what you think is best clinically.”
“We need to code for what is needed, and what we need to do, not what the insurance will cover or won't cover for them.”
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