Although ICD-10 is mostly used in medical offices and hospitals, it could be a potential requirement for procedures performed in dental practices if the procedures are billed on a medical claim form or sent to certain insurance payers.

Although ICD-10 was mandated by CMS, it is the "new normal" for coding in the healthcare insurance industry, not just for Medicare and Medicaid, so even if your office does not bill procedures to Medicare or Medicaid, you may still be required to comply with ICD-10 with your other payers.

Every medical insurance payer in the US was federally mandated to change from ICD-9 codes to ICD-10 codes for diagnoses included on claims by October 1, 2015. Claims are paid based on medical necessity and if you are not submitting the correct diagnosis codes, you may receive partial payment or possibly no payment at all. Although ICD-10 is required, the government has approved the delay of a few insurance payers because they have not updated their claims processing systems. Workers Comp has not made the transition from ICD-9 to ICD-10, but there are also few more out there. Providers need to confirm with each insurance company on rejected claims. California, Maryland, Montana, and Louisiana have Medicaid insurance payers with a government approved "crossover" method of processing claims. Providers must send claims with ICD-10 codes, but the payers switch those codes back to ICD-9 before fully processing and paying the claims.

There are dental practices that do not perform procedures that require ICD-10 codes. Here are examples of dental procedures that may require a medical claim form and/or the use of ICD-10 codes:

- TMJ Procedure repairing a joint membrane or cutting of a muscle

- Oral Surgery Procedures like sialodochoplasty or repositioning teeth

- Maxillofacial Surgery Procedures like maxillary sinusotomy or repairing maxillofacial defects

- Oral Sleep Apnea Appliance Therapy

In addition to medical claims requiring ICD-10 codes, several state Medicaid agencies require using diagnosis codes in conjunction with procedure codes on dental claims. According to the ADA, Arizona, Iowa, Maine, Michigan, and Nevada Medicaid insurances have versions of diagnosis code requirements for dental claims. These differ by state so providers will need to confirm what each insurance company requires.

If you have never used ICD-9 or medical claim forms in your dental practice, ICD-10 probably does not apply to you. However, if procedures are performed that are billed on medical claims or if dental claims are submitted to any of the above-mentioned state Medicaid insurance payers, this transition will affect how your diagnoses are coded and if your claims will be accepted and paid.

Author Bio:

Tiffany Yanagida is a Certified Meaningful Use Administrator, Certified PQRS Healthcare Professional, and the head of the MacPractice Meaningful Use Support Department. She represents MacPractice in the HIMMS Electronic Health Records Association as a member of the Meaningful Use workgroup and the Vice Chair of the Certification workgroup, which consult with and advise ONC and CMS.

MacPractice has supported 600 providers in their Meaningful Use of ONC-ACB Certified MacPractice software.