April 03, 2014
Due to the nearing ICD 10 compliance deadline, there is brouhaha over various aspects of ICD 10 including codes, transition, HIPPA, etc. But the role of documentation in ensuring successful reimbursement under ICD 10 standards is finding minimal mention in this ICD 10 noise. As much as clinical documentation is important for all medical areas for ICD 10, its role is particularly significant for dental practices given the degree of specificity that a dental claim has to include to be successful.
The main difference between ICD 9 and ICD 10 is that ICD 10 is much more specific in nature, with number of codes many times more than ICD 9, with the ability to account for minutest of dental details through an intricate network of codes. And each code used has to be supported by documentation to establish its necessity. A breakdown of a dental procedure will exemplify it.
For a procedure like edentulism, ICD 10 needs mention of which specific area the caries are localized to, pulp, dentin or enamel, and the exact cause of tooth loss. Additionally, whether the decay is Traumatic or Pathologic needs to be mentioned. There are separate sets of documentation depending on whether it’s Traumatic or Pathologic to communicate such details as encounter type, healing nature, location, etiology, etc. Similarly, for open wound, ICD 10 requires documentation detailing the type and cause of the wound.
As you can see, the level of detailing documentation ha depends on the complexity of the condition (very detailed and holistic in case of edentulism but not so for open wound, a simpler condition), but all conditions require documentation under ICD 10. And, because documentation supports the codes used, lack of documentation can lead to claim rejection or under payment.
Proper documentation requires a thorough documentation process running together with the dental procedures absorbing and archiving records as they pile up in the course of a treatment procedure and then passed on to billers and coders who would accurately use them to support their claims. So not only will a dental practice need thorough documentation but also billers and coders sufficiently familiar with intricacies of dental procedures.
MBC’s Revenue Management Consulting services can help you with this by helping you assess your In-house revenue management cycle and ensuring that there is sound coordination between various components of your dental practice facilitating smooth flow of data. This will help you develop a comprehensive documentation which is among the key to successful claims under ICD 10. We can also guide you in training your staff to handle dental records and pluck such details from them as would be required to meet reimbursement needs. Additionally, we will help you to set up proper software platform to transport your document back and forth while preparing and submitting claims.
Medicalbillersandcoders.com the largest consortium of billers and coders in the US, has been helping several small to medium size dental practitioners with its Outsource medical billing services by guiding them to prepare proper documentation and coordinating with them to ensure their optimal and accurate use. Our service modules are flexible and you can pick and choose those parts of our service that you would require our help with.