Medical and dental coding have many similarities and are not as different as we in the dental profession are led to believe. All healthcare providers render services such as office visits, radiographic imaging services, etc. healthcare providers are also required to document what services are rendered and why a service is needed in a health record.
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.