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Coding for Office Visits in Dental: Profitable or Risky?

51 Physician Medical Groups (PMG) transactions were announced during January 2023, a 35% decline from January 2022 when 79 PMG deals were reported. The retail-like dental specialty, however, seems to be more sheltered from the recessionary pressures: it had the most transactions, representing approximately 24% of all January 2023 PMG acquisitions, an increase from January 2022 when dental represented more than 20% of the PMG deals.

Farragut expects dealmaking in this sector to continue to outpace other sectors as dental groups work to establish large platforms and explore strategies to fuel their growth. An essential aspect of this growth is evaluating opportunities within the existing revenue cycle of a practice. 

Dentists—especially specialists like oral maxillofacial surgeons—navigate between medical (CPT) and dental (CDT) code sets. The most frequent of these crossover codes are used for office visits or evaluation and management (E/M) codes. E/M medical codes provide a significant bump in reimbursement value compared to the oral exam/evaluation codes. However, a lack of proper understanding of when to use these codes could become a billing integrity pitfall. 

Billing a high-level E/M code also means the provider adequately established the medical necessity for a more comprehensive exam and additional testing. If the supporting documents do not fully support an E/M visit and go unchecked without regular audits, the related coding may be construed as manipulation. Our auditors look at the type and amount of information in a chart note to establish the best use scenarios for a visit-related code. We also train and educate providers and their staff with relevant case studies to reinforce these best practices in billing and coding.

Farragut has consulted hundreds of dental platforms on how to discern the grey crossover zone of medical versus dental billing and enhance the quality of their earnings with the correct code usage.

It is possible to achieve high levels of accuracy in coding for medical claims of dental visits and procedures. For thorough transaction diligence or post-acquisition process improvement, hit reply below to speak with our dental industry-leading experts. They have the business acumen to help you confidently take the next strategic call.

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