Teresa Duncan, MS gives another great tip on dental coding. Why would hygienist need to be fully aware of dental codes? Teresa explains why our documentation can make or break dental claims. For more info from Teresa, see below!
Teresa Duncan: Speaker on insurance and management, Podcaster, Author of a book and contributes to several magazines and the ADA’s publications!
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For your viewing pleasure this TIPisode has been transcribed:
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date, and presented by the experts in the profession. Now, get ready for your unofficial TIPisode.
Teresa Duncan: Hi. This is Teresa Duncan of Odyssey Management and the host of the Nobody Told Me That! podcast. It’s a pleasure to be back here on the A Tale of Two Hygienists podcast. I was asked recently why hygienists actually need to know codes. And I know that the response to the last podcast about 4346 was very positive, so I think there’s a lot of you that know the codes and want to know more. But I wanted to give you a more of a high level of why the coding is important from a hygienist’s point of view.
It’s important for you to not only know what is included in the code set, that’s definitely important, but from the admin’s side, why do we need certain pieces of information from that code set?
One of the mottos that I have — I’ve been saying this for a couple years — is that documentation drives revenue. And what that means is we can submit claims all day long, but if we don’t have the appropriate revenue to go along with that, then, unfortunately, we have claims that come back to us. And that’s why you will often have a new insurance coordinator come up to you over and over again for information, and you’re thinking, “Well, geez. It’s right there in the chart.” If it’s right there in the chart, theoretically, we have everything that we need.
What helps is if you understand exactly what it is that we need to send in. From a hygiene point of view, it’s very simple. Actually, it’s super simple. From a dental point of view from the dentist’s side, there’s a lot more that goes on. But from a hygiene point of view, really what we need is current perio charting within a year, and complete perio charting. Not just spot probing, complete. And then we also need a nice set of radiographs. Whether it’s a full set, whether it’s bitewings, we need them to be within two years. That’s really what we’re looking for.
Anything that you put in your notes regarding certain situations, extenuating circumstances such as patient has systemic diseases, all of that, that’s just icing on the cake. It’s great to have, and we so appreciate it, so make sure that you have that in your notes.
The other part about documentation driving revenue, what you should keep in mind is that if you are aware of the most common snafus with certain codes, you can anticipate that and give us a heads up administratively that this may be an issue. So, if you’re aware that most of the osseous surgery codes require a certain millimeter of pocket loss or bone loss, then you’ll be already anticipating that.
Now, let me give you a real life example. You may have a patient who is really inflamed, bleeding all over the place, but the bone loss is really not — it’s not a five; It’s not a six. It’s a four, sometimes some threes, but you’ve got some really heavy inflammation. But it is more than just the scaling with inflammation. You and your doctor have decided that you’ll be doing scaling and root planing in those areas.
You can give a heads-up to the administrative team that “Look. This is kind of a borderline case. What I’m going to do –” and I would do this in your notes — “is make more in the narratives, I’m sorry, more in your documentation that the patient has all these existing other conditions, risk factors.” Perhaps they have a history of smoking, they have a history of drug abuse, all of that. That way my administrative teams that I teach, or used to teach, they would go in and they would look for that, and they would beef up their narrative more than just the usual. That would help us to avoid rejections, and then that takes even more time.
So, if you’re aware of the different snafus that happen with these codes, then you’re already ahead of the game because you can help us out. You and your admin team can work together on that. If an admin team member comes to you — this is one of the other reasons — if an admin member comes to you for help with a narrative, you will know the code well enough to give them an accurate and reasonable narrative.
If you’re not familiar with the actual verbiage in prophy — we all think prophy is a cleaning — but go in there and look at it and see if it actually says anything about healthy tissue, soft tissue, anything about inflammation. Does it say anything about that? And then you can noodle through what it is we’re going to put in as a narrative. Of course, we’re not making anything up. That’s important. But what is in your notes that you could use as a narrative?
So that makes you think, “If I have a lot of information in my notes, then that helps with having a good narrative.” I’m not saying you over document. I don’t want you to do that. But what I want you to do is make your documentation consistent so you’re not working harder every time. So, if your template consists of risk factors, what is the perio assessment? What is the staging and grading? You’ve got all of that with the AAP that’s come out, and you need to have that in your notes. So, hopefully, you’re going to incorporate all of that.
It’s very important that you not just know the theory of coding, that you just know this one set of codes that hygienists use the most, but it’s really important for you to understand the importance of accurate coding that goes along with it.
Hygienists, I can get claims paid for the work that you do if I have the good, proper documentation that goes along with it. And this is the same thing that I say to doctors all of the time. Many times we’ll go in, we’ll take a look at what the documentation looks like, and I can’t get reimbursement for a crown buildup if nothing in the notes even corresponds to what is in the description of a crown buildup. Same thing for grafting and extractions and all of that. I can’t get your surgical extractions paid if you actually didn’t touch or augment the bone in any way. That’s important to know, but if you haven’t read the codes then, of course, you’re not going to know about it.
If this is the first time where you’re thinking, “Oh, geez. Now I need to know all the codes.” Just grab the code book once. You’ve read worse stuff in hygiene school. I know you have. Just grab the code book once, sit down and look at the perio codes, and see if there’s anything new in there that you have any questions about. I am sure that most of you will look at it and it will look very familiar, so it’s almost just like a revisiting. But if you haven’t done this before, I do believe it’s a very important part of your day to know what the codes are.
One thing that I will tell you that admin team members, when I get them into a course, I can always tell who has an office with the clinical team not on board with documentation, whether it be the doctor, the hygienist, whomever. I can always tell because those people are always beyond frustrated because they want to get the claims paid, but the documentation is just not there. And, of course, you’re not going to make things up. That’s unethical. But they can’t get it paid if the documentation’s not there.
So it’s super important for hygienists to take the bull by the horns on this. You are super important in this whole process, and the more your offices get paid, the more we can reinvest into new technology, into teams, whether it be salary, bonuses, whatever it is. But the more you have to write off, the more that eats into your salary, your bonuses, your technology. So let’s take it in the other direction.
Please check out my podcast. I know that’ll be in the show notes, so check that out. It’s Nobody Told Me That! If you have any other questions about insurance, I’m available online. Odessymgmt.com. I have a book about insurance conversations that could help you, and an online course, so check that out if you’re interested. And I do have a newsletter that talks all about insurance and management. So, if insurance is floating your boat, you may want to sign up for that. That’s available also on my website. Until the next time, this is Teresa Duncan with Odyssey Management.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at firstname.lastname@example.org, and keep listening for more awesome content from your unofficial dental hygiene podcast.
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