How to Navigate Cross Coding Speed Bumps
Part 2 of a 3 Part Series
Cross coding to medical can be a very difficult implementation in a dental practice. It can be done successfully but there can be a lot of frustrations along the way. This article is my second article dealing with how to manage what I refer to as cross coding speed bumps. If you haven’t read the first article, please access that article to get the full list of solutions. So let’s look at these speed bumps.
Speed Bump #6 – Software problems
There are a number of dental practice management software programs that have cross coding components. I hear from many staff members about some of the difficulties they have dealing with these programs, so using them is not always a good answer to efficiently implement cross coding.
My Solution:
If you are content with the software that you have to cross code with, then I see no problem with continuing to use it. You avoid the cost of new software and it can work seamlessly with your ledgers by having a record of medical claims submitted. However, for most of those who are dissatisfied with the software, there are some other solutions. Companies such as SpeedyClaims and Availity offer fill in the blanks type of software and there is the added benefit that these claims can be submitted electronically. It is time consuming to fill in the blanks but it will give you a clean claim to either print or submit electronically. Also, there are some low cost medical software programs that can be used (e.g. Total MD, Kaero, MediTouch). These will create claims automatically without having to fill out the claims but you will have a separate set of ledgers to keep up with. If you can handle two sets of books and you will be submitting many medical claims, then this may be a good solution for you. Some practices still handwrite medical claim forms. I do not encourage this because those claims can never be scanned which results in delays in processing.
Speed Bump #7 – There are some big differences in entering procedures between dental and medical.
Medical insurance has certain requirements when entering procedures on a claim that are different than with dental. Attendees of my course have questioned why they can’t fill in a medical claim form with each tooth’s procedure listed separately as is done on the dental claim form.
My Solution:
Medical insurance has two important areas that are different from when we complete a dental claim. First of all, they pay on a tiered system which means that the first listed procedures will get the highest benefit and the following procedures are not paid as highly. Therefore, when we cross code, we should always enter the most expensive procedures first so that they will get the highest benefit. The second difference is that medical does not want the same procedure code to be listed more than one time per date of service. So if, as an example, you were submitting four third molar extractions and the same procedure code applied to each, you would only enter the procedure one time on the medical claim. Then, in the days/units box of the claim, enter a 4 (four units of that procedure code). You would also need to multiply your fee by four. The only time that you would want to list the same procedure an additional time is if there was some difference between it and the first one. In that case, you would enter it a second time but use a modifier code to explain how it was different.
Speed Bump #8 – The procedure wasn’t paid because the EOB states the code is invalid.
When incorrect codes are used, denials stating “invalid code” are a common occurrence.
My Solution:
First of all, remember that the medical code sets update annually. You must stay on top of that to be sure you are not using outdated codes. The ICD-10 diagnosis codes seem to have the most updates each year. Another area to consider is whether you are choosing the most specific diagnosis codes. The ICD-10 code set is comprised of codes based upon categories. Within these categories there are sub-categories and then sub-categories of those sub-categories. So you must look carefully in the category that pertains to the claim to determine the most specific diagnosis code. In addition, there are some claims that require extension codes and, if not added, will be invalid. This applies to many trauma claims and they are used to indicate if the visit is an initial encounter, a subsequent encounter, or a sequela (late effect of an injury) encounter. These extension codes are required to be placed in the seventh position of the code. The problem develops when you are using a four or five digit code and you need to add an extension code as the seventh digit of the code. The method used for these situations is to enter the letter X as a placeholder either once or twice in the fifth or sixth or both places, depending upon how many digits the diagnosis code has. Not following these rules can cause a claim to deny.
Speed Bump #9 - Using the highest level exam code can be dangerous.
I have seen reports of dentists being fined for the use of the highest level evaluation and management codes.
My Solution:
Medical benefits are higher when we choose the highest level of the evaluation and management procedure codes. However, there are huge requirements for using those high level codes that most general dentists do not do. It is much safer for the practice to use a lower level code such as 99202 for new patients and 99212 for established patients. Practices that don’t have documentation to prove that they have met all of those requirements for the higher level codes when they have submitted them can face some big problems.
We have now looked at an additional four important speed bump solutions. We'll complete the solutions list with my final article in this series in next week's edition of AADOM Insights. You'll be armed with solutions that should help your practice more efficiently implement cross coding without as many frustrations.
Marianne Harper is the owner of “The Art of Practice Management”, your BEST resource for cross coding success. Marianne’s specialty is coaching dentists and staff members in implementing dental-medical cross coding. She is the author of a dental-medical cross coding manual for dental practices titled “CrossWalking – A Guide Through the CrossWalk of Dental to Medical Coding” as well as an eBook series titled “Abra-Code-Dabra”, and she provides multiple resources to help dental practices implement cross coding. Marianne is also a published author of dental practice management articles and is a well-respected speaker and coach. For additional information, please check Marianne’s website www.artofpracticemanagement.com.