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ADA assists members in transition to ICD-10

August 11, 2015

By Kelly Soderlund

A small number of dentists who participate in certain state Medicaid programs will no longer be able to use the ninth revision of the International Classification of Diseases to report diagnostic codes on their claims.

The ADA is preparing to assist members during the transition to the next version, ICD-10-CM.

After Sept. 30, dentists who take Medicaid patients and those covered under the Health Insurance Portability and Accountability Act will not be able to use the ninth revision of the International Classification of Diseases, and the ADA is preparing to assist members to transition to the next version.

After Oct. 1, ICD-9 Clinical Modification will not be available for reporting purposes. ICD-10 CM will be the standard diagnostic code set but not all states are yet requiring affected dentists to use the updated codes. Currently, only state Medicaid programs in Nevada and Arizona have across the board requirements for reporting diagnosis coding information in dental claims.

"There are only a limited number of dentists who are affected by this change but given Nevada and Arizona's move to require all dentists to report ICD in dental claims, we want to educate our members and prepare them for the possibility that reporting with ICD-10 may be in their future," said Dr. Ronald Riggins, chair of the Council on Dental Benefit Programs Subcommittee on the Code.  

Dentists who do not take Medicaid patients may be required to use ICD in limited situations. Some commercial plans have identified specific dental procedures that may minimize the risks associated with the connection between the patient's oral and systemic health conditions. These dental plans may provide additional benefits for conditions such as diabetes, pregnancy or heart conditions. Diagnosis codes will continue to be required for medical claims for oral and maxillofacial surgery and/or anesthesiology services.

ICD-10 CM is the latest version of the disease classification used in the United States to record many types of health and vital records, including death certificates. Europe is already using ICD-10 and is working to implement ICD-11.

The primary purpose of ICD clinical modification codes is for epidemiological tracking of illness and injury. In health care, diagnosis codes are used as a tool to group and identify diseases, disorders and symptoms.

State Medicaid programs that require ICD reporting want to capture clinical data to support public health activities, the development of evidence-based benefits plans and to efforts for increased funding. The ICD reporting is also required to facilitate payment for services related to the oral-systemic connection and coverage for additional dental services for certain medical conditions.

The ADA has prepared a number of resources to help members understand ICD reporting and the transition from ICD-9 CM to ICD-10 CM:

  • ICD-10 CM educational materials on ADA.org, including a PowerPoint presentation and a sample claim form explaining how to report diagnostic codes on an ADA claim dental claim form. These are available at ADA.org/icd10.  
  • ICD-9-CM coding examples for coding procedures codes are available on the ADA Center for Professional Success and will be updated to include ICD-10-CM coding examples before Oct. 1.
  • The CDT 2016 Companion will include a chapter with new and revised codes that correspond to ICD-10-CM codes. CDT 2016 goes on sale this fall.
  • On Nov. 4, the Standards Committee of Dental Informatics will host a symposium titled Taking the Mystery Out of Dental Coding: A Standards Perspective in Washington, D.C. immediately prior to ADA 2015 – America's Dental Meeting. The event is open to anybody interested. For information on how to attend, contact standards@ada.org.  

"There are a lot of uncertainties when it comes to reporting claims with diagnostic codes," Dr. Riggins said. "We created these resources so that dentists can be prepared and educated if they are in the position to begin documenting and reporting claims using ICD-10.