Dental vs. Medical – Why the Two Are Coded Differently
Not sure about anyone else out there, but my mouth is part of my body. At least last time I checked. It’s been right there on the front of my face for as long as I can remember. Now, come to think of it, I am sure about everyone else. I have yet to see any person whose mouth is separate from their body.
You think I’m ridiculous right now and rightfully so. But the idea, as simplistic and obvious as it is, has a real practical argument. The question isn’t whether your mouth is part of your body. The question is, “Why doesn’t my doctor examine my teeth and gums?” Or perhaps “Why doesn’t my dentist put me on a scale and ask if I exercise?”
Dental Excluded in 1840
Dentistry has always been separate from medicine in the United States. The story of the University of Maryland College of Medicine’s rejection of the addition of dental education, and the subsequent opening of the first college of dentistry across town is a notable event. That was 1840. Medical and dental schools are partitioned to this day. That’s not unique, however, when you consider podiatry, chiropractics, and optometry also are taught separately. But education is only a fraction of the picture.
Here’s a timely bulleted list of distinctions between dentistry and general medicine:
- Education (Yeah, I said it before. It’s important though.)
- Payment models, and the insurance industry
- Durable equipment and suppliers
- Professional associations
- Documentation and record requirements
- IT markets
- Trauma services. Let’s expand that in one paragraph…
Dental Care in a Medical Setting
Say you get in a little fender bender. Nothing serious, and it wasn’t your fault because we like you. Your car’s airbags deploy and fracture your upper central incisors (8 and 9). There’s a little blood and a lot of pain, especially when you breathe through your mouth. You’re a lot less dazed when the ED doctor rouses you with, “Rough day?” … (Hum of fluorescent lighting) … You also notice your hands are Q-tips. “Well, the burns on your hands will go away in a few days. We’ll send supplies home for you to change your Q-tips,” she says. You smile a little and your teeth scream at your brain. She turns to walk out saying “You’re going to stay here a while until you’re not so woozy. I gave you some pills for the pain but it’s going to be hard to find an after-hours dentist around here and you can’t drive so you need to wait until morning to get your teeth fixed.” She says all in one breath. And suddenly your teeth are merely speaking conversationally to your brain. That’ll be the drugs. You lay back, sinking into the plushest butcher paper on the market, and complain, “I have to try to sleep with my heart pounding in the front of my face?” “Sorry about that.” The doctor replies, inspecting the tile on the floor. All you can think to say is “Yes, I am having a very rough day. Thanks for asking.”
I just made that story up and I still feel bad for you! The partitioning of trauma care is weird. Why treat the mouth like it’s been henceforth banished from the kingdom of your body? The bad news is, we’ve been doing it this way for a long time and patients have suffered the painful inconvenience just like you did in my fictional rambling.
Maybe now you’re thinking I’m not so ridiculous. But you already know medicine and dentistry are separate. That’s just how it’s always been. So, what’s the point? The point is that I can comfortably proclaim that the separation is not as distinct as I’ve suggested. In fact, the gulf dividing the two for decades now looks more like a canal crossed with charming little walking bridges.
Harvard’s dental school made one of those bridges 150 years ago:
“Harvard dental students have always spent more than a year of their education attending the same classes as their medical school peers. They learn just as much about what’s going on in the chest cavity as the oral cavity. Under a new curriculum, in their second year they work in a primary care clinic in the dental school, side by side with fourth-year dental students, nurse practitioners, and primary care physicians to learn how to assess a patient’s overall health.”
- Bruce Donoff, DMD, Dean, Harvard School of Dental Medicine
Dentists as Doctors
Dentists are doctors, too. Oral health is significant to overall health. Harvard is not the only dental school with this type of holistic curriculum, in fact, most modern schools are training dentists as oral physicians. It’s a prudent approach considering poor oral health is linked to hypertension, heart disease, diabetes, pregnancy complications, and the pungently obvious, halitosis.
So, what about your fictionally fractured teeth? Well, here’s more good news. Many hospital systems employ dentists to handle dental trauma, a trend with huge patient benefits. Turns out it’s a big deal for non-trauma cases too. Your fender bender story was – well, it was what was, but it’s far from the only story. Chances are that you or someone you know has had major dental work. There’s a good chance that work was billed to a medical carrier. And it goes beyond wisdom tooth extraction.
Payment models are slowly evolving too. Cross coding and billing for dental services has become commonplace. Cross coding sounds like a bridge to me, but really, it’s just a term for billing medical insurance for dental services. This is momentous when you think about it. Particularly considering the limitations and lagging availability of dental benefits. A patient can have dental services, diagnosed as medically necessary, billed to their medical insurance plan. It’s an option beneficial to both patients and providers. We’re seeing medical carriers increase their dental related coverages. We’re seeing dental carriers and Medicaid dental programs require diagnosis codes on claims. We’re seeing dental practice software systems include options for medical billing. Non-credentialed staff reporting CPT and ICD-10-CM codes is instant anxiety for certified medical coders, believe me, I know, but it’s happening. They share our frustrations and our passion for accuracy (nice words to acknowledge our perfectionism, right?). We can learn from them while we welcome and accept our colleagues. Besides, there’s always training. Enter AAPC.
I’m lucky to have helped with AAPC’s new Dental Billing and Coding training. From my perspective AAPC stands on its own charming little walking bridge. 30 years of coding gives our bridge a good patina of lichen and moss. We’re proud of that. For our dental colleagues, we welcome you and eagerly anticipate all we’ll learn from one another. We confidently affirm that the mouth is indeed part of the body and we’re hungry to help end its banishment.
- Dental vs. Medical – Why the Two Are Coded Differently - April 12, 2019