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Medical Cross-Coding: Untapped Revenue



Billing against medical insurance can be an untapped revenue source in most dental practices, and is becoming more important in today’s challenging economic environment. Medical cross-coding, as it is called, lets you bill medical insurance for certain procedures such as:

  • Oral surgical procedures
  • Medically necessary implant procedures
  • Medically necessary periodontal procedures
  • Medically necessary laser procedures
  • Consultations and examinations for orofacial medical conditions
  • TMJ procedures
  • Procedures associated with oral dysfunction
  • Dental procedures related to trauma
  • Screenings for oral cancer
  • Dental procedures for myofascial pain conditions
  • Sleep apnea procedures
  • X-rays, including medically necessary CT scans associated with the procedures above

Learning how to medically cross-code makes sense for both your practice and your patients for several reasons.

Leave dental benefits available for non-medical procedures
Most dental policies have a limited yearly benefit, while medical policies typically have annual deductibles. Once the deductible is satisfied the plan will continue to pay benefits unless the patient reaches a lifetime maximum benefit. When you can bill the medical insurance for oral health procedures that are medically necessary it leaves the dental benefits available for non-medical procedures. This advantage cannot be overstated when you consider that an average dental plan may only pay $1,500 in dental benefits, which can easily be consumed in a single root canal or crown.

Offer patients better savings on major procedures
Patients benefit from medical cross-coding because of the more favorable copayment terms offered by the average medical insurance. Typically dental plans will cover 50% of the procedural costs. Most medical plans offer a more generous copay, with 80% of reasonable and customary charges being common. When you can offer patients that level of savings on major procedures they are more likely to make medically sensible decisions and they are also likely to have greater loyalty to a dental practice that, in their eyes, offers more affordable care.

Dentrix makes it automatic…
Dentrix includes a comprehensive medical insurance cross-coding system that allows you to quickly bill both medical and dental carriers for the same procedures. The Medical Insurance feature gives you the flexibility to flag certain dental procedures as billable to medical insurance and to cross-reference the ADA code with the appropriate AMA-CPT, ICD-9, Modifier and Service codes. The system allows you to cross-reference an ADA code with the corresponding medical codes. In addition, you can cross-reference the ICD-9CM diagnostic codes with the corresponding AMA code from the Medical Cross Coding Setup utility.

…And easier than ever
Due to licensing issues with the American Medical Association, we cannot preload Dentrix with the AMA-CPT, ICD-9CM, Modifier and Service codes. However, you can add these codes manually to the system. Once the medical codes have been added, you must link the ADA code with its AMA code counterpart.

Entering the medical codes manually can be a time-consuming and error-prone process if you don’t understand how the medical codes work. That’s why we’re pleased to offer the Cross-Coding DataPak—designed for practices that do not want to spend the time researching, adding and linking the medical codes in Dentrix. The Cross-Coding DataPak makes cross-coding a snap by adding all of the codes and links for you.

The most current version of the Cross-Coding DataPak is compatible with the 2011 CPT codes and ICD-9-CM codes. For more information about this product, please contact us at 1.800.DENTRIX.

Medical Cross Coding 6.0 is available now. To get started purchase today.



Author: Jay Wood
Published: 6/24/2011