If you’re a dental practice that works with medical insurance, there are important changes on the horizon you’ll want to be aware of for 2021!  Here’s a quick look at some of the important 2021 Medical Billing updates that you need to be prepared to implement.

Be Sure to Be Prepared for these 2021 Medical Billing Updates 

  1. ICD-10 diagnosis coding updates (which go into effect October 1 of 2020),
  2. The new Medicare ABN form
  3. A major overhaul to the evaluation & management (E&M) coding requirements that simplifies documentation and codes selection.

Evaluation and Management Code Changes

Perhaps the most exciting change: Starting in 2021 evaluation and management codes are more likely to be based on time spent with the patient along with the dentist’s medical decision-making process from your SOAP narrative reports.  So be sure to document the visit in SOAP format (subjective complaints, objective exam findings, assessment & plan) to help the medical insurance carrier understand why they should pay as opposed to dental.

No one likes changes, especially in a year with so many changes. However, the E&M coding changes will likely be a positive change for dental practices performing exams for oral appliances for obstructive sleep apnea, TMJ disorders, oral surgeries, bone grafts, frenectomies, tooth extractions, oral infections, and other treatments billed to medical insurance.

 2021 ICD-10 Coding Changes

There are many ICD-10 codes to choose from, depending on the patient’s symptoms or diagnosis. But not all of them apply to medical insurance in the dental office. In fact, only a fraction of the diagnosis codes available apply to medical billing for dentists.  One thing you can always count on Nierman Practice Management for, is to isolate the 1CD-10 diagnosis codes for that apply to billing medical insurance in the dental office.  And that’s a very good thing since there are now a total of 72,616 ICD10 diagnosis codes! For ICD-10 2021, there are:

  • 490 additions
  • 58 deletions
  • 47 revisions

Nierman Practice Management has scoured the ICD-10 codes to isolate the updates and changes that are important to dental practices that bill medical insurance for their patients.  Remember, many procedures that are performed in the dental practice setting can be billed to medical such as sleep apnea appliances, TMJ disorder services, and oral surgical procedures.

For 2021, the ICD-10 changes mostly affect the TMJ disorder, headache, and craniofacial pain realm for dental practices. The E&M coding changes affect all practices!

A pertinent example of the results from all this scouring is an ICD-10 coding change for the headache code, ICD-10 R51.  Many dental practices use this diagnosis for head and facial pain.  R51, headache, has been deleted.  Not to worry though.  We found that codes have been added back to replace it.

Stay current with all the coding changes for medical billing and help your patients receive needed treatment with Nierman Practice Management. NiermanPM has solutions to help dental practices grow. We have online and live courses in medical billing in dentistry, taught by cross-coding icon Rose Nierman. We also have our Nierman Medical Billing Services, which is comprised of medical billing in dentistry experts who understand and know how to implement the 2021 Medical Billing updates for you. As the Nierman Practice Management team knows, if you have a claim to file, ‘there’s a code for that”.

Article by: Rose Nierman & Courtney Snow