The Dental Billing Podcast

2024 Dental Coding Changes and Understanding New Claim Form Updates (part 1)

• Ericka Aguilar • Season 6 • Episode 6

Share episode

Get ready to demystify the labyrinth of dental billing changes coming in 2024! You'll gain invaluable insights into the American Dental Association's new service category, Sleep, and how this addition increases the dental categories to a total of 13. We'll break down how these extra codes can lead to more precise interactions with providers and patients, and why this doesn't automatically mean insurance payouts will increase. 

Then, we'll pivot to understanding the intricacies of the 2024 claim form, shedding light on the new boxes and their role in speeding up the claim process. You'll understand why it's crucial to get your practice management software updated with the 2024 claim form. We'll delve into new additions such as Box 3A and 11A, which require payer IDs, and Box 39A, which demands the last date of scaling and root planning. We'll also unravel the complex concept of locum tenens, and the introduction of the new Box 53A to identify temporary providers. So, tune in and arm yourself with the knowledge to navigate these changes smoothly!

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka or Jen? We would love the opportunity to discuss your billing questions!

Email Ericka:
ericka@dentalbillingdoneright.com

Email Jen:
jen@dentalbillingdoneright.com

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)


Want to know what your fee should be for D4346? Send Ericka an email to ericka@dentalbillingdoneright.com


Speaker 1:

Welcome back to the Dental Billing podcast. I'm your host, erica Aguilar, and let's just dive into today's episode, friends. I am excited about this one. In today's episode, we're gonna talk about the 2024 changes and updates that are happening and we all need to be aware of them because it is going to impact our money and our income in 2024 if we don't keep up with these changes. So there's some exciting stuff happening. I'm really happy that the American Dental Association's Coding Committee has finally acknowledged and added a new category of service to the Dental Categories of Service. We will have a sleep category of service in 2024. So currently we have 12 dental categories of service and in 2024, we're going to have 13.

Speaker 1:

So what does that mean? That means we're gonna have more codes to properly codify interactions with our providers and our patients. You guys, this is huge. I am a huge fan of having proper coding with the interactions our providers are having with their patients. Now, that does not always mean that just because we have a code, it's going to get paid by insurance. Insurance and codes have nothing to do with each other when we're talking about coding and interaction your ability to code an interaction accurately and the ability to tell a story through the codes is what we're looking for. It adds more accurate detail to the interaction, so I'm excited. Whenever we get new codes added and we have the ability to properly codify an interaction, it makes me happy. So your girl is super happy right now.

Speaker 1:

Now, with the addition of the codes, there's also gonna be some revisions and there's no deletions this year. So in 2024, don't anticipate anything to be deleted. We have 15 codes that are being added and four new sleep-related codes, a new sleep category of service and some other codes around implants, and we will get to that in part two, today's episode. We are going to focus on the 2020 for claim form. We are going to be introduced to a new claim form and, friends, there are some really exciting changes with the claim form that you are going to want to be aware of, and I'm really excited to share this with you. So let's just dive into what those changes are going to be.

Speaker 1:

So the first one that we want to be aware of with the 2024 claim form and please, before I dive into all these changes, do yourself a favor and contact your practice management software and ask them to add the 2024 claim form to the claim options that we have. So a lot of times we will log into a practice remotely just to kind of take a look around and do this mini assessment of how their billing department is going, and one of the areas that we look at is which claim form they are using. Because, friends, we still have offices that are using the 2006 claim form, just not realizing and not paying attention to the updates. And not only has it been updated a few times, we're jumping into the 2024 claim form. We want to make sure that we are using ICD-10 codes when we are billing. And that's a whole other part two podcast to the original ICD-10 episode I did a while back. So contact your practice management software, make sure they are going to be adding, or be aware of when they are going to update the claim form format that you are currently using with your practice management software. You don't want to miss these updates. It's going to affect your billing if you don't get updated on this 2024 claim form.

Speaker 1:

So, 2024 claim form updates. They've added some boxes and they've added boxes to take away from having to write certain narratives in the remarks section of the claim form. So what are those boxes that have been added? Whoa. Box 3A has been added. To add the payer ID to the claim form. It is not necessary to process the claim. The instructions indicate that if you do not have the payer ID, then you just leave that section blank. However, when we have sections to fill out on a claim form, we want to make sure that we are properly filling them out. Your current claim form whether you're using the 2019 version, the 2020 version do not have the ability to put the payer ID on the claim form. So Box 3A and 11A are asking for the payer ID. So 11A is asking if there's any other insurance involved. If so, then you're going to add the payer ID for the secondary insurance on the claim form. So those are fairly straightforward and simple.

Speaker 1:

Box 39A this one is a biggie, this is a good one 39A asks for the last date of scaling and root planning. So what does that mean? That means that we no longer need to create a narrative that indicates the last time the patient had history of scaling and root planning. As you know, when you bill periomainense D4910, you know that we need to indicate in the narrative when the patient had history of scaling and root planning. So the American Dental Association has recognized that or has received enough complaints from providers about this narrative and the confusion it causes not necessarily confusion, let me take that back the delay it causes in payment. When, say, we forget to put the history of SRPs in the narrative in the remarks section? They've listened and they've added a box and this is why you want to make sure that you get with your practice management software, because you want to have the ability to fill in box 39A date of last scaling and root planning. That's going to help process your claims a lot faster for the procedures such as periomainense that require history of scaling and root planning. So that's a big deal because, as you guys know, a lot of our claims are auto-adjudicated. Okay, now let's get to the biggie about the 2024 claim form.

Speaker 1:

If you have followed my podcast for some time, you have heard my episode on locum tenants locum tenants providers. This has been very confusing for billers that understand locum tenants and then the majority of the billers out there don't even know what that means and how it applies to billing. So let's first talk about what locum tenants is. What is locum tenants? That's a very fancy Latin way of saying temporary provider. That's my translation for those of you that don't understand what locum tenants is In the billing world.

Speaker 1:

When we have a temporary provider, maybe our doctor went out on disability, maternity leave or we had a main provider pass away. Now we have a temporary treating dentist. That is what is referred to as locum tenants. When we have a temporary treating provider, we are supposed to put that provider's license and NPI number on the claim as the treating dentist. Does that happen in most offices? No, it does not. Why does it not happen? Because the majority of my fellow billers do not know of locum tenants and how it applies to billing, or they find that it is way too messy. Fussy Insurance companies can be very fussy about this, and by that I mean, in addition to adding the locum tenants provider on the claim form as the treating provider, some insurance companies, like Delta Dental, want you to fill out a separate form indicating and providing proof as to why we have a temporary provider, and they will not allow vacation to be one of the reasons why you have a locum tenants provider.

Speaker 1:

So we need to understand that, with this addition to the 2024 claim form, this is box 53A Locum Tenants Treating Dentist. So now we have an additional box where, in the event we have a temporary treating dentist on staff to cover for our main dentist, we have a box where we can indicate that this was a locum tenants dentist. Part two to this episode is going to be after I am done with my research about the main insurance carriers and how this box being added to the claim form may or may not change the administrative paperwork that is required in order to add a locum tenants provider. So when we are talking about these insurance protocols, I am trying to figure out if we still need to fill out these additional forms in order for our doctors to go out on disability or, in some cases, go on an extended vacation. And while you have a temporary dentist there, we want to make sure that we are indicating the correct treating dentist, whether it is an associate or a locum tenants doctor. We want to make sure that we indicate the correct rendering provider In some cases when we are adding a locum tenants doctor to our practice.

Speaker 1:

Additionally, what we are trying to find out is if they have contracting requirements for credentialed providers. Credentialing and contracting are two separate things. I hope that we understand the difference between the two. Credentialing is getting a dentist recognized within a network. Contracting is when we are adding a provider to an existing contract. So if we are adding an associate or a locum tenants provider, that is a contracting scenario. That is not a credentialing scenario. I hear these two terms used very commonly, interchangeably and incorrectly, so we want to make sure that we understand. With this new box being added, we want to know do we still have to go through the contracting process or does this box allow us to place the locum tenants provider on the claim form, thereby helping the insurance company to understand that a locum tenants provider rendered services to these patients and it was rendered under the existing contract terms?

Speaker 1:

A lot to digest there. I know I unpacked a lot, so let me know if you guys have any questions with that. Very cool that we have this box 53A adding locum tenants treating dentists to the claim form. That's going to provide a lot more clarity and I do love this. Now, box 56A is not new for 2024, but I do want to talk about it since we are talking about updating our knowledge with regards to the 2024 claim form.

Speaker 1:

Box 56A is where we are going to place the taxonomy code. What is a taxonomy code? The taxonomy code indicates the specialty that we offer within the practice. So if your doctor is a general dentist, we will use that taxonomy code. If your doctor is a periodontist, we use the periodontist taxonomy code. I have noticed though it's not a requirement with some insurance plans. I've noticed that we are receiving denials for lack of having the taxonomy code on the claim form.

Speaker 1:

Don't get the insurance company's excuses to deny, delay or reject your claims. Just make sure that you understand the boxes and the requirements in these boxes for the claim form. The insurance company claim processing guidelines continue to get extremely restrictive and they are getting very fickle with how they process claims. So let's move on to being that. That is what's happening with claim processing in today's billing landscape. Don't give them a reason to deny, delay or reject. Just understand and follow the process. If you need a list of taxonomy codes, I'm going to place a link to those codes in the show notes and feel free to go and find your appropriate taxonomy code. And if you don't know how to add this to your claim form, contact your practice management software and they will walk you through and show you how to add the taxonomy code to box 56A. If you can't find box 56A on your claim form. It's probably because you're using an old claim form, so make sure that you have the most recent up-to-date claim form. Once you have all that ironed out, it will be automatically added. It should automatically get added to all of your claims.

Speaker 1:

Since we're on the topic of claims, let me just mention, for those of you that know this, this is a refresher point. For those of you that don't, take note Always submit your UCR fees on your claim forms. Never, ever, submit the contracted rate. Insurance companies expect that you are placing the UCR fee on the claim form because the American Dental Association says that this is best practice when you are dealing with an insurance company. So make sure that we're following those ADA guidelines and placing our UCR fees on the claim form. Since we're on the topic of UCR fees, make sure that you are updating your fees every year because, in the event you do want to ask for higher contracted rates, they are going to take a look at the last 90 to 120 days of what you have been submitting on your claim forms. We want to make sure that our UCR fees are up-to-date when we do ask for that increase in contract rate. All right, we have talked about 2024 claim form changes and updates and all of that exciting stuff. We are not done yet.

Speaker 1:

There are two revisions that have been made for 2024. One of them is a biggie and I think it's going to provide less confusion around D2335. So we all know that D2335 is your four or more surfaces composite restoration. This is for an anterior tooth. However, the revision for 2024 deleted the mention of the incisal angle because the incisal angle is not a tooth surface and it caused a lot of coding confusion as well as claim payment delays. So the American Dental Association's coding committee decided to X out incisal angle and now we no longer need to provide proof of an incisal angle being involved with anterior composite for or more surfaces. So that's exciting. I think that that's great. I think that provides a lot more clarity around that code. And the other revision is D5876. This is add metal substructure to an acrylic full denture per arch. When we are adding a metal substructure to strengthen the prosthesis, that is when it would be appropriate to use D5876. So that's a really good revision. The descriptor was changed and modified to add the fact that we are adding metal to the substructure of the acrylic denture. So those are the two revisions and the claim form updates and boxes that are going to be added in 2024.

Speaker 1:

My suggestion to you, your takeaway from this, is contact your practice management software, make sure that these revisions are going to be updated, including the revisions for the two codes that we just mentioned, d2335 and D5876. Make sure that you have those revisions noted in the practice management software and make sure that your practice management software is going to add the 2024 ADA claim form. That is going to wrap it up for today's podcast episode. As I said, this is a shorty episode, that it's a powerful episode and, friends, it is part one.

Speaker 1:

I am going to continue to do my research with regards to locum tenants and any changes that are happening within the insurance companies, as we have a new box on the claim form to indicate our temporary providers. The clarification that I want and it's probably going to be for, like the top five main players, like Delta, cygna, guardian, etna is do we still need to go through this contracting process when we are going to bring on a temporary provider, or is it going to be assumed that, by adding this box to the claim form, that the locum tenants provider is going to assume all of the terms within the existing contract to that practice. So there's a couple things I'm still researching, getting some clarification around, so bear with me and I will release part two, probably within the next 30 days. In the meantime, I will be releasing some interviews that I've done with some awesome individuals that are doing a great job in dentistry and we'll be talking about their contributions to dentistry. Couple of them are Morgan Millett from Front Office Friend I can't wait to release that episode and also Kira Dent with the Dental A team. So stay tuned for those two amazing women who are doing some good things in dentistry, and I can't wait to share those episodes with you.

Speaker 1:

But in the meantime, if you have any questions, feel free to reach out to me. My email is in the show notes. You can also text me. My number is in the show notes as well. Hit me up on LinkedIn. I always love to connect with my listeners on LinkedIn, so let's connect on LinkedIn. Send me a message, let me know what you think about this podcast and, friends, if you find value in the content that we provide with the Dental Billing Podcast, we would love for you to write a review, share your thoughts, share this with a friend. As always I try and be very intentional about the worth that I provide and make sure that it's worth the use of your time, the value of your attention. So I appreciate you. Thank you so much and I will see you in the next episode.

People on this episode

Head Shot

Ericka Aguilar

Host