DIAGNOSIS CODING IN DENTISTRY

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# DIAGNOSIS CODING IN DENTISTRY
## ⚔<br/> EDWIN M. KAGEREKI
### BDS, MSC, FRSS
### updated: 2020-01-27

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# Session Goals

- To understand the principles of coding in healthcare.

- Appreciate the need create a standardized diagnosis code set.

- Appreciate the potential for better analysis once these codes are implemented.

- Have some examples of common diagnosis codes in general dentistry.

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# Different types of codes

1. Procedure codes:

- Services performed on patient.
  - Examples: CPT, HCPCS, CDT codes, Inhouse codes - Mater procedure codes, KMPDB fee schedule.
  
2. Diagnoses codes:

- Symptoms or diagnoses associated with services.
  - Supports medical necessity for the service.
  - Example: ICD codes.
  
Together provide comprehensive and complete picture of a patient visit.

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# Coding purpose

- A standardized system by which diseases, disorders, injuries and other
medical problems may be classified.

- Informs patient treatment plans, claims payment, development of
clinical best practices, and population risk assessment and adjustment.

- Code describes patient’s diagnosis, symptom, condition, or complaint.

- A growing requirement by the payers to have coded claims.

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![](Coding-in-Dentistry_files/figure-html/unnamed-chunk-1-1.png)

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# Coding purpose

# Diagnosis coding systems in dentistry

- [ICD (International Classification of Diseases)](https://icd.who.int/browse10/2016/en)
 
-  [SNODENT](https://www.ada.org/en/member-center/member-benefits/practice-resources/dental-informatics/snodent)

- [DDS](http://dentaldiagnosticterminology.org/)

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# ICD 10

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# Introduction

- ICD is a medical classification list by the WHO. 
- Contains codes for diseases, signs and symptoms, findings, complaints, social circumstances,  causes of injury or diseases. 
- WHO provides detailed information regarding the ICD via its [website](https://icd.who.int/browse10/2016/en) – including an ICD-10 online browser and ICD training materials. 
- There are different versions of ICD:

a. ICD-10  and was first used in 1994: Examples of recent ICD 10 versions
 
 - ICD-10 2016 (Current version)
 - ICD-10 2015
 - ICD-10 2014 version
 - ICD-10 2010 version
 - ICD-10 2008 version
 - ICD-10 2007 version
 - ICD-10 2006 version
 - ICD-10 2005 version
 - ICD-10 2004 version
 - ICD-10 2003 version 
 
 b. Other versions include version 9 and 11(released in 2019)
 
 c. Sometimes there is need to change from one version to another. 
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# Structure of ICD-10

Understandign the structure of ICD-10 code:

.pull-left[

- Length: 3-7 digits
- First character: Letters except U
- Characters 2: #
- Characters 3-7: # or letter
- Decimal: After 3rd character
- Letter format: Case-sensitive
]

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![Example 1:](C:/Users/Clinic 2/Desktop/CME/images.png)

Application in dentistry:

![Example 2:](C:/Users/Clinic 2/Desktop/CME/Untitled.png)

]

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# Oral- systemic interactions of diseases

- Both medical and dental diagnosis codes are combined  into one code set.

- Dental codes are found mostly in Chapter 11, Diseases of the Digestive System (K00-K95).

- Requires dental provider to be familiar with ICD- 10 codes that represent a patient’s medical diagnosis as well as their dental diagnosis.

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# Overview of codes in the main categories dentistry - K Codes

- Diseases of Oral Cavity and Salivary Glands (K00-K14)

- K00 Disorders of tooth development and eruption

- K01 Embedded and Impacted teeth

- K02 Dental Caries

- K03 Other diseases of hard tissue of teeth

- K04 Diseases of the pulp and periapical tissues

- K05 Gingivitis and periodontal diseases

- K06 Other disorders of gingiva and edentulous alveolar ridge

- K08 Other disorders of teeth and supporting structures (incl. Loss of teeth)

- K09 Cysts or oral region, not classified elsewhere

- K11 Diseases of salivary glands

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# Overview of other categories in dentistry - M Codes

Diseases of the musculoskeletal system and connective tissue

- M26-M27 Dentofacial anomalies [including malocclusion] and other
disorders of jaw

- M26.6_ TM joint disorders

- M26.62 Anthralgia

- M27.3 Alveolitis of jaws

- M27.5_ Periradicular pathology assoc. with prev. endodontic treatment

- M27.6_ Endosseous failure of dental implant

- M27.62 Post-osseointegration biological failure of dental implant (lists
reasons including poor OH)

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# Combination Codes for Commonly Associated Symptoms and Manifestations

Example: Diabetes associated with periodontitis

- E08.630 Diabetes mellitus due to underlying condition with periodontal disease

- E10.630 Diabetes mellitus Type 1 with periodontal disease

- E11. 630 Diabetes mellitus Type 2 with periodontal disease 3

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# Where to find the codes?

1. [The WHO site](https://icd.who.int/browse10/2016/en)

2. Other Sites. eg [Codes](https://www.mm3admin.co.za/documents/docmanager/a5cab770-04bb-435c-a872-bc5227ce5590/00024373.pdf)

3. HIS.

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# Internal uses of diagnosis coding

- Risk adjustment mechanisms

- Proper clinical protocols

- Develop best practices

- Track health and disease conditions

- Designing payment systems and processing claims for reimbursement

- Insurers use information to determine medical necessity and whether service should be covered

- Measure quality and efficacy of care

- Preventing and detecting healthcare fraud

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# External uses of diagnosis coding

- Data used to asses and track health trends and epidemics

- Conducting research, studies, and clinical trials.

- Setting health policy

- Monitoring resource utilization

- Disease management programs

- Directs outreach

- Standard documentation and nomenclature across medical community

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# Thanks!