Dental Practices and ICD-10

As a rule, most dental practices will not use ICD-10 diagnosis codes because they do not use ICD-9 diagnosis codes today. Dental prior approvals and claims submitted using American Dental Association (ADA) codes do not require the use of diagnosis codes. Dental practices will continue their use of Dental Procedures and Nomenclature (CDT-2015) codes for reporting procedures on dental prior approval requests and dental claims for payment.

However, there are exceptions to this rule. For dually eligible Medicare and Medicaid beneficiaries, dental services covered by Medicare must be billed to the beneficiary’s Medicare Part B carrier on a CMS-1500 form. Currently, it is necessary to file such Medicare claims using Current Procedural Terminology (CPT) codes, published by the American Medical Association and ICD-9 diagnosis codes. Effective October 1, claims requiring diagnosis codes must be billed using the ICD-10 codes, not the ICD-9 codes that are used today.

Dental practices using ICD-9 codes today can see how they convert to ICD-10 codes in the NCTracks ICD-10 Crosswalk. (See link below.)