You know the story well. In fact, you’ve probably experienced it at some point in your life. That excruciating, brain-rattling pain that overwhelms you while you’re drinking hot coffee or taking a bite of ice cream. The pain and hyper sensitivity that a week of Sensodyne can’t compete with.
But just in case you’re lucky enough to have avoided this dental phenomenon, here is a story about a root canal leads to us to the focus of this brief article, tooth sensitivity and proper coding practices regarding dental diagnoses and procedures.
“Just a year ago I was experiencing extreme sensitivity and pain on the right side of my mouth. If I took a bite of ice cream, took a sip of ice cold sweet tea or my favorite caramel frappe, ate food that was fresh off the stove and piping hot, or had a piece of extra-sweet candy; my mouth was rushed with paralyzing pain and there was nothing I could do to stop it! Finally, I went to a local dentist. Surely enough, I had a cavity and it was a monster! I had to have a root canal.”
Tooth sensitivity or Dental Hypersensitivity/Dental Sensitivity is defined as intense and transitory pain that is caused by the exposure of the internal part of teeth to the oral environment and occurs when contact is made with an external stimulus. Tooth Sensitivity is the most prevalent cause of dental pain. Healthy teeth have layers of enamel for protection, under the gum line is cementum which protects the tooth’s root, and under that is dentin. When the protective layers of your teeth become damaged or compromised in any way, hypersensitivity can create an uncomfortable environment in your mouth, and oh boy what an uncomfortable environment! Just as with my experience the pain is triggered by things such as hot or cold food and drinks, acidic food, and excessively sweet food. Much like my experience, when that pain persists beyond the point of being able to self-manage you have to seek professional expertise for a diagnosis and/or procedure to treat it.
As a medical coder you have to be prepared to assign correct procedural and diagnoses codes. Dentists use Current Dental Terminology (CDT) when completing their billing procedures. CDT is a code set with descriptive terms developed and updated by the American Dental Association (ADA) for reporting dental services and procedures to dental benefits plans. However, many patients have coverage for dental-related trauma under their medical plans. This means that dental office personnel have to be proficient in the recently mandated ICD-10 coding system. Different causes of dental hypersensitivity or sensitivity are cavities, fractured teeth, worn fillings, gum disease, worn enamel, or exposed root. For reimbursement purposes you have to be prepared to assign correct ICD-10 codes when necessary. The codes listed in the chart below don’t list “tooth sensitivity” but they do list some of the causes that you might have to diagnose.
Some of these codes are:
|K00||Disorders of tooth development and eruption|
|K00.4||Disturbances in tooth formation.|
|K00.5||Hereditary disturbances in tooth structure, NEC|
|K00.6||Disturbances in tooth eruption|
|S02.5XXA||Fracture of tooth (traumatic)|
|Z96.5||Presence of tooth-root and mandibular implants|
In addition to being familiar with necessary ICD-10 diagnoses codes, you may also have to utilize certain procedure codes located within the CPT manual. The Center for Medicare and Medicaid Services(CMS) has developed a “Crosswalk of CPT Codes to CDT Codes”. It is intended to be viewed as a tool to assist in reporting CPT codes on the dental lines of a CMS-416 Form. It is not intended to serve as the universe of CPT codes related to dental care, nor as a set of CPT codes which describe only dental-related procedures. CMS refined the crosswalk and released an updated version prior to April 1, 2016.
The coding changes implemented October 1, 2017 removed some codes previously used for tooth sensitivity. 2016 ICD-10-CM Diagnosis Code K08.8, other specified disorders of teeth and supporting structures, is an example of one of these codes. Assigning accurate codes for diagnoses and procedures is necessary due to the ever-changing policies and procedures in the coding world. To ensure proper and accurate coding practices follow the steps you normally do; Identifying the need for the visit, consulting your indices for primary diagnoses and procedures as listed in the plan for treatment, and double check your tablatures to make sure you select the most precise code. Even when coding diagnoses and procedures relate to tooth sensitivity, you can rest assured that you are prepared to accurately assign correct codes for reimbursement.