Since When did Dental Claims Require Diagnosis Codes?

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The objective of the Accountable Care organization is to integrate and consolidate patient care management to improve patient outcomes. Changes and coordination of dental and medical care are already becoming more apparent when dental offices are being required to bill a patient’s medical plan for dental visits due to an accident, trauma, sleep apnea, cancer treatment, or oral surgery.  

Several states are currently mandating the use of ICD-10-CM codes reported along with the dental codes. For example, Arizona requires a diagnosis code reported on a claim form if the reason for the visit is an underlying medical condition. Check with your state Medicaid for requirements with ICD-10-CM codes reported on a Dental claim form. 

In addition, other government payers require the use of diagnosis codes such as BCBS Federal; it is expected for other payers to adopt the use of ICD-10-CM in the future. Check with commercial dental plans on policies requiring the use of medical diagnosis codes. The ADA form has a place to report up to 4 diagnosis codes with a diagnosis pointer indicating the treatment line it is referring to. 

The benefits of providers reporting the treatment associated with ICD-10-CM will support areas such as the capture of clinical data, which will assist in supporting evidence-based benefit plans. Healthcare recognizes the relationship to the oral-systemic connections and the need for additional dental services for patients with certain medical conditions.

There are many resources to get your practice started using ICD-10-CM codes; keep in mind there are 69,000 ICD-10-CM diagnoses. However, Dental offices will only use a fraction of these codes, so don’t let the complete set of diagnosis codes overwhelm your staff.

Dental providers will mainly code from chapter 11, K00-K14 Diseases of oral cavity and salivary glands. Take a few minutes to get familiar with the different sections used when reporting ICD-10-CM codes; it is not as complicated as it may seem.


K00.0K00.9  K00 Disorders of tooth development and eruption
K01.0K01.1  K01 Embedded and impacted teeth
K02.3K02.9  K02 Dental caries
K03.0K03.9  K03 Other diseases of hard tissues of teeth
K04.01K04.99  K04 Diseases of pulp and periapical tissues
K05.00K05.6  K05 Gingivitis and periodontal diseases
K06.010K06.9  K06 Other disorders of gingiva and edentulous alveolar ridge
K08.0K08.9  K08 Other disorders of teeth and supporting structures
K09.0K09.9  K09 Cysts of oral region, not elsewhere classified
K11.0K11.9  K11 Diseases of salivary glands
K12.0K12.39  K12 Stomatitis and related lesions
K13.0K13.79  K13 Other diseases of lip and oral mucosa
K14.0K14.9  K14 Diseases of tongue

Written By: by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS


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