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ICD10 Basics and SNODENT

There is a low grade buzz in dental circles regarding the new diagnostics codes called ICD10 that are set to go into effect at the end of the month. Thankfully dentistry is still for the most part exempt from these new rules unless you are treating patients and seeking reimbursement from Medicare or ACA (Obamacare).

From Road to 10:

About ICD-10 The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets on October 1, 2015. ICD-10 consists of two parts:

  • ICD-10-CM diagnosis coding which is for use in all U.S. health care settings.
  • ICD-10-PCS inpatient procedure coding which is for use in U.S. hospital settings.

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims:

  • Claims for services provided on or after the compliance date should be submitted with ICD-10 diagnosis codes.

Source: Road to 10: The Small Physician Practice’s Route to ICD-10 ICD-10 Basics – Road to 10: The Small Physician Practice’s Route to ICD-10

There is a diagnostic code system for dentistry called SNODENT which stands for Systematized Nomenclature of Dentistry. It is intended to establish standard diagnostic criteria and definitions and a standard digital format that can be used by everybody as part of a digital electronic medical / dental record. The concept is great, but.

As a general rule dentist have not been diligent in making and recording diagnosis. We often conflate the treatment and the diagnosis. For example we will say the diagnosis is a crown. Of course that is not correct the crown is a treatment the diagnosis might be a broken or decayed tooth. One of the reasons we do this (besides habit) is that we have codes for treatments but not for diagnosis.

The proper way to do it is to make and record a diagnosis and then to prescribe a treatment. The SNODENT system is designed to be the recording system for diagnosis – which is good – but breaks down when so few of us make formal diagnosis.

The second problem is the steps involved. Not only do we have to develop a new habit that is making a specific diagnosis we have to fit it to a SNODENT code and then enter the code in the record. And we have to do this for every treatment. Even a prophy technically needs a diagnosis.

One of the great benefits of standard diagnostic codes is that they can be used for research. Which diseases are most common? Which treatments are most effective? In other words SNODENT codes are needed to do effective evidence based analysis.

It is hard to argue with the concept of evidence based treatment planning as a concept. However in reality it has been used in medicine to limit treatment options, reduce reimbursements and stifle creativity and innovation.

Never the less the concept is excellent and dentists need to do a better job of making and recording standard diagnosis.

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