Improve Dental Revenue Cycle Management with Treatment Code Standardization

November 30, 2023 | 4 min read

Effective dental revenue cycle management (RCM) is critical for healthy cash flow and your organization’s financial health. Unfortunately, many practices fail to maximize profitability because of cumbersome and confusing treatment code management.

Standardizing your coding procedures can help ensure accurate billing, reduce administrative burden, and get paid faster.

“By implementing standardized coding procedures across an organization, dental practices can reduce errors and improve overall financial efficiency. Consistent, internal organization of these processes is crucial to successful data governance and reporting.” ~ Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper.

Here’s a 5-step action plan to improve your coding practice:

1. Identify Frequently Used CDT and Alternate Codes Across Your Organization

Make a list of CDT codes your practice uses by reviewing your dental practice management software (PMS), billing records, and submitted claims. Then, examine a sample of past claims, treatment records, and invoices to identify frequently used codes. 

Get insights and input from your staff — for example, some may prefer specific codes or variations based on their experience. You may also use the reporting features in your PMS to generate a list of frequently used codes.

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2. Consolidate Codes That May Cause Confusion For Billers and Stakeholders

Collect all existing codes used throughout your practice and create a master list. Look for duplicate codes that represent the same procedure or service but have different code descriptions. Engage your staff, including billers, dentists, and hygienists, in the review process — their input can help identify duplicates. 

Reference official coding resources, like the American Dental Association's (ADA) CDT Code Book, to cross-check code descriptions. Choose one standard code description to represent a specific procedure or service and consolidate all similar codes under it. Update your dental practice management software and documentation accordingly to reflect the consolidation.

Communicate the consolidated codes to all employees and provide education to minimize confusion and ensure consistent usage. Also, update patient records, billing templates, and other documentation to reflect the consolidated codes.

3. Identify Codes That Require Additional Documentation or Have Alternate Benefits

Sometimes, you may use different codes for the same procedure, like charging a different fee based on age group or tooth location. Start by reviewing the descriptions of CDT codes used in your practice. They often provide information about the procedures, including documentation requirements and fee variation based on various factors.

Next, review payer contracts to understand reimbursement rates and documentation requirements for these procedures. Also, analyze billing records and claims to identify patterns related to codes that require additional documentation or have varying fees.

Create a reference document or database of these codes. List specific requirements or variations for each and make the code record easily accessible to staff for quick reference. Then, integrate the information into your PMS and mark these codes (e.g., flag them and add notes) so billers know when one requires a different workflow.

4. Document Standard Operating Procedures (SOPs) For Codes With Special Workflows

Define the purpose of the SOP by explaining why a code requires a unique workflow and the desired outcome. Providing the context will help your staff understand the rationale behind the procedure and empower them to take the appropriate action.

Then, create a step-by-step outline of the workflow. Include details such as documentation required, pre-authorization processes, patient eligibility criteria, when to use the code, etc.

Specify the personnel responsible for each step and set a timeline. Document communication protocols, such as notifications, approvals, and information transfer between team members. Also, identify potential issues and include guidelines or solutions to minimize bottlenecks and delays.

5. Review Payer Contracts For Split Codes

Review all insurance payer contracts and determine which CDT codes in your practice are considered split codes. Review sections on CDT codes and fee schedules and see how the payer treats split codes. Attachments and addendums to these contracts may contain detailed coding and billing guidelines regarding split codes.

If a contract is unclear about split codes or doesn’t mention them explicitly, contact the payer to inquire about its policy and request written documentation for your record. Then, compile the information and set up the split codes in your PMS. You may need to create separate entries for the same procedure code to specify different fees or allowances based on payer requirements.

Get The Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper


Ready to learn more about revenue cycle management? Get The Revenue Cycle Management (RCM) Best Practices for Enhanced Dental Practice Performance white paper. 

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