Notably, dental health is a fundamental component of overall wellness. States are mandated to offer dental coverage to children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) (Medicaid.gov, n.d.). Nevertheless, states decide whether to offer dental benefits to adults. Medicaid covers dental treatments for all child registrants as part of a comprehensive package of benefits, namely “the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit” (Medicaid.gov, n.d., para. 2). Though oral screening may be a component of a medical examination, it is not a substitute for a dentist-performed dental checkup. According to the state’s periodicity plan, every child must be referred to a dentist.
Every patient encounter involves a code, and the practice’s responsibility is to apply the most specific codes when submitting third-party claims and in regular paperwork. Finkbeiner and Finkbeiner (2019) state that general dentists, specialists, and other individuals, including dental hygienists, may report any of the CDT codes mentioned if they are performing operations and providing services within the extent of their state legislation. The CDT guideline encourages uniform, consistent, and accurate recording of services offered. The codes support three critical services and are not restricted to submitting third-party reimbursement requests. Finkbeiner and Finkbeiner (2019) acknowledge that regulations are used to record services provided and as crucial documentation in an electronic health record. As dentistry improves to integrate established oral-systemic linkages, diagnosing patients’ diseases before treatment begins is critical. Documenting and reporting diagnostic codes are changing. Using standardized clinical data and diagnosis on a dental claim is not yet a common practice; nonetheless, some state Medicaid programs already demand it (Finkbeiner & Finkbeiner, 2019). Particular third-party insurance provides additional benefits for specific medical problems. Including this easy step can help to optimize dental claims and improve medical cross-coding.
References
Finkbeiner, B. L., & Finkbeiner, C. A. (2019). Practice management for the dental team (9th Ed.). Elsevier.
Medicaid.gov. (n.d.). Dental care.