Codes are used to report services rendered to insurance payers for reimbursement determination. We communicate to payers through applying codes to the claim form, whether medical or dental. So yes, it is similar with each code set having a specific purpose. In this article, we will do a deep dive comparing how medical coding and dental coding affect your claim submissions.
Why do code sets exist in dental and medical billing?
Why do code sets exist? The HIPAA (Health Insurance Portability and Accountability Act) requires the use of standard transaction code sets for a consistent method of submitting electronic data to insurance companies for processing and paying claims. This article will review the various code sets that may be used by your dental practice when filing claims and their purpose, as it applies to dentistry.
Below is a brief explanation of these standard transaction code sets.
Why do code sets exist in dental and medical billing?
Why do code sets exist? The HIPAA (Health Insurance Portability and Accountability Act) requires the use of standard transaction code sets for a consistent method of submitting electronic data to insurance companies for processing and paying claims. This article will review the various code sets that may be used by your dental practice when filing claims and their purpose, as it applies to dentistry.
Below is a brief explanation of these standard transaction code sets.
CDT (Current Dental Terminology)
This is the normal the code set we in dentistry, and are most familiar.
- Used to report dental procedures
- May be used to report procedures to dental and medical insurance payers (when accepted)
- Maintained by the American Dental Association (ADA)
CPT® (Current Procedural Terminology)
- Also referred to as Level I codes
- Used to report procedures to medical payers only, never dental payers
- Maintained by the American Medical Association (AMA)
ICD-10-CM (International Classification of Diseases, 10th revision, Clinical Modification)
- Referred to as diagnoses codes
- Communicates to the dental and medical payer information about a patient’s dental or medical condition(s) requiring the treatment listed on the claim form
- Medical payers require at least one diagnosis code on the medical claim form
- Some dental payers require diagnoses codes on the dental claim form
- Maintained by CMS (Centers for Medicare and Medicaid Services)
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