How Helping Them Can Help You

The Value of Implementing a Dental-Medical Cross Coding System

By Marianne Harper

Has it happened in your practice yet – you receive a letter from a patient’s dental carrier telling you that they will not consider the dental claim until you file with the patient’s medical insurance carrier first? If your practice is like most dental practices, you have no idea how to file a medical claim and you have no idea of how you will obtain any benefits for your patient if you don’t file a medical claim first. Take notice – this situation is happening more and more frequently around the country.

Dental-medical cross coding is your answer. Learning this system is not as difficult as you might think. Implementing a cross coding system in your practice will not only help you handle the situation that the dental carriers have created but it will provide a way for you to make a significant difference in making medically necessary dental procedures much more affordable for your patients. If medical insurance will cover those medically necessary dental procedures, treatment plan acceptance can greatly improve and the accounts receivable can decrease. Also, you will find that those patients who you have helped by providing them with a way to better afford their medically necessary dental procedures will become your number one champions and they will help to market your practice. As you can see, implementing cross coding can make a significant difference in your practice.

What you may not realize is that many of the dental practice management software companies provide cross coding components to their software. So you may already have the tools to cross code. This helps to keep the costs down for implementing a cross coding system for many dental practices.

You should now see the answer to why we should make this implementation but the next question will most likely be “how do we do it”. Let me help take away the fear of learning this new system by providing several options:

  • Purchase a dental-medical cross coding manual – There are several such manuals that can be purchased. I am the author of one that is titled “CrossWalking – A Guide Through the CrossWalk of Dental to Medical Coding.” These manuals provide a basic learning tool for cross coding. In addition, these manuals should provide the medical codes necessary to file these types of claims. When deciding on which manual to choose, check to see if there is an update service for the manual that will keep your manual current with the yearly medical coding updates.
  • Even better is to combine the purchase of a manual with attendance at seminars or webinars that teach cross coding.
  • The best and most thorough method for learning cross coding is through on-site training.

Your last question may be “what dental procedures can we file medically.” In order to file dental procedures medically, you must establish that the dental procedure is medically necessary. Medically necessary procedures are those that are for diagnosis or treatment of a medically necessary dental condition, prevention of a medical condition, improvement of a medical condition, or for rehabilitation of lost skills. Many dental procedures can fall into one or more of these categories. So let’s look at some examples:

  • Any dental procedures performed due to trauma
  • Many dental surgical procedures
  • Sleep apnea appliances
  • Biopsies
  • TMD procedures
  • Perio procedures for patients who are medically compromised by diseases, medical conditions or by medications
  • Procedures performed to provide a dental clearance prior to surgery
  • Medically necessary implants – those that are needed as the result of loss of teeth due to trauma, a medical condition, or a genetic condition; or where bone atrophy has resulted in dentures that won’t seat well, thereby causing difficulties with chewing and getting good nutrition.

Currently, dental sleep apnea treatments that are filed medically are gaining momentum. This is a very strong area for dental practices to pursue. The U.S. Department of Health and Human Services reports that more than 45 million Americans suffer from sleep apnea with eight hundred thousand being diagnosed each year in the USA. Sadly, only 10% are actually being treated. These statistics should be driving a point home – a good number of your patients probably suffer from sleep apnea. With the greater successes in filing these claims medically (including with Medicare), dental sleep apnea procedures could be a very productive addition to your procedure mix.

You can see that there is definitely a need for dental practices to implement this coding system. The need is there and the benefits can be substantial. If you would like more detailed information, please visit my website, www.artofpracticemanagement.com, or give me a call at 252-637-6259. I would love to help you with this important system. You will find that helping them definitely can help you!


Marianne Harper is the CEO of The Art of Practice Management. Her areas of expertise are revenue and collection systems, business office systems, and training dental practices in dental-medical cross coding. Marianne is a well respected consultant, trainer, lecturer, and author. Her published works include “CrossWalking – A Guide Through the Cross Walk of Dental to Medical Coding” and her “Abra-Code-Dabra” series on medical cross coding for sleep apnea, TMD, and trauma procedures. She is also the author of many articles published in dental journals.

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