The Rationale Behind Medical Dental Necessity—It’s No Longer All About Fixing Teeth

Dr. Charles H. Mayo, who was a highly respected medical authority in the 1900s and also one of the founders of the renowned Mayo clinic, saw that far ago what medicine has overlooked for nearly 100 years—that “dentistry is a branch of medicine.”

Fast forward 2015, dentist and orthodontists are now required to adopt a certified electronic health record (EHR) system, similar to their medical counterparts. EHR will require the dentist to manage oral diseases by determining the medical necessity. Dental medical necessity is the responsibility of the clinicians, which requires them to reason why a procedure is required and accurately documenting the same. The key to diagnostic coding is accurately determining the “why” of the dental-medical care being performed.

Dental practices can increase their profitability by accurately cross-coding to determine and document dental-medical necessity. For instance, in dental office many procedures may meet the criteria for benefits through medical insurance. The medical insurance of a patient may reimburse for oral disease complications or causes. Dentists should bill for all services performed with the knowledge that each state has a statute specifying that medical insurers cannot deny a claim if the care is within the provider’s scope of practice and the treatment is medically necessary.

The rationale behind Dental Medical Necessity is not as complex as it seems. It can be defined as—

• Service provided is the most appropriate;
• Diagnosis is consistent with the symptoms;
• Treatment is consistent with the diagnosis;
• Treatment is not primarily for the convenience of the patient or provider; and
• Treatment is good dental-medical practice.

Dentist should treat every patient as if they qualify for medical coverage and can be cross-coded. Medical necessity is imperative for successful medical coding, and learning how to determine and document it will take your practice forward. Timely documenting medical necessity can also optimize coverage under dental policies. Plus, it’s also a step forward in getting ready for electronic health records profitably.

To learn more about the Dental Medical Coding, check our audio conferences www.profedondemand.com/medical-coding-billing/dental-practice.html