Medical Coding on Dental Claims

As of October 1, 2015, medical diagnostic codes are now needed on certain dental claims. Why? The decision dates back to 2009 when the Centers for Medicare and Medicaid Services pushed for an expansion of the medical classification codes (at that time it was ICD-9) to ICD-10, which just went into effect on October 1. The move to ICD-10 was needed due to changes in healthcare regulations and the insurance industry. Now ICD-10 codes are required in all HIPAA covered transactions on or after October 1, 2015.


While it’s true that the shift to ICD-10 codes primarily affects medical claims, there are a number of situations now where medical diagnostic codes are required for dental claims—ADA claim forms even have a place for diagnostic codes.

Dental practices that do surgical procedures such as surgical extractions will notice the biggest change as insurance companies not only require the ICD-10 diagnostic code, but some dental carriers will also require you to first bill medical insurance for the procedure. Practices that see Medicare and/or Medicaid patients may also be required to provide ICD-10 codes. Finally, practices may discover that some Affordable Care Act insurance plans require ICD-10 codes when you provide pediatric services that are mandated by the plan.

Child at Dentist

Therefore, prepare yourself by getting some training on ICD-10 codes. For starters, you can find an informative article about the arrival of ICD-10 codes in the recent edition of Insurance Solutions Newsletter.

Fortunately, your dental practice will not have to contend with the over 69,000 codes in the ICD-10 book; instead you just need to know a handful that will hopefully ensure prompt processing of your claims.

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