CDT Coding and Claim Attachments: Keep Your Revenue Flowing by Using the Proper Codes and Attachments for All of Your Claims

To maintain a steady flow of revenue, ensure your practice submits all dental claims with accurate codes and required attachments. Here are some tips for submitting claims that are approved on the first try.

• Current CDT Coding: Keep your software updated with the latest CDT Coding as soon as possible. This ensures you have the most current information. If your software doesn't automatically remove outdated codes, do so manually. This upfront effort will save your practice from the hassle and financial loss of resubmitting rejected or denied claims.

• Know What to Attach: Each insurance company has its specific "mandatory" attachments for procedures, but there are common attachments needed for most procedures.

  • Crowns: Include a periapical x-ray showing the entire tooth, including the apex, and intra-oral pictures showing decay.

  • Crown Build-ups: Attach a periapical x-ray of the whole tooth, including the apex, and intra-oral pictures. It's beneficial to add a narrative explaining the need for the build-up. Most insurers require at least 50% of the tooth to be damaged or decayed to justify a build-up restoration.

  • Night Guards: Provide a narrative explaining the medical necessity (usually Bruxism).

  • Perio Scaling and Root Planing: Include current periodontal charting, a full mouth series of x-rays, and a narrative explaining the need for periodontal treatment. Some insurers, like Aetna, require the time needed to complete the procedure.

  • Fillings: Some insurers require x-rays and/or pictures showing decay. Be sure to know which ones before filing claims.

• Get a Detailed Insurance Verification: Understand your patient's benefits thoroughly. If your current software, insurance web portals, or faxback of benefits don't provide the information you need, make phone calls and ask questions. This upfront work will save you time and money when filing claims.