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Why Proper Coding Is Essential For Dentists


Dentists are the experts at helping patients achieve optimal health. That’s what they do best. Coding and billing? Not so much.

Dentists have to be reimbursed for their services, just like any other medical professional. This means having knowledge of proper billing and coding procedures. But not all do. Dentists don’t often think about the importance of using proper codes, but they should. Coding and billing tasks are often left to receptionists and medical assistants who may not have this knowledge. They try to fake their way through it, with disastrous results. Improper coding can lead to a slew of issues, including jail time and license loss.

Proper procedure coding is important, as it helps for accurate payment for dentists and creates a valid record of patient care. When dentists use inappropriate procedure codes, it can lead to all kinds of issues for dentists and can have negative outcomes for patients.

Accurate procedure coding is not only a moral issue but also a legal requirement. It comes with serious consequences for dentists who fail to follow the regulations. Even when the improper coding is done on accident, it is considered misconduct. Some examples of coding misconduct include:

  • Charging excessive or unreasonable fees.
  • Charging for dental services that were never performed.
  • Submitting false or misleading services or charges for services rendered to a patient.
  • Falsifying a record related to a patient exam.

Proper coding is important for the patient record. It aids the billing process and expedites payment. In addition, procedure codes can be used to analyze what diagnoses and treatments a dentist has made. They are also used to compare dentists. For example, the number of extractions, fillings, and root canals performed reveal a lot about a dentist’s treatment philosophy and how they practice.

Misuse of codes can set off alarm bells with insurance companies. Insurance companies don’t play around; they have sophisticated ways of identifying and investigating fraud. They have several options available to them, such as:

  • Investigating claims submitted over a two-year period or longer.
  • Demanding money back from overpayment due to the billing errors.
  • Contacting patients and informing them about the potential fraud, which can damage a dentist’s reputation.
  • De-listing a dentist or entire office, meaning that the insurance company will no longer accept claims submitted by them and will not reimburse them for treatment.
  • Reporting the dentist to the appropriate regulatory body, meaning that the state board may get involved and charge the dentist with a criminal complaint.

Keep Your License With Help From a Tampa Dentistry License Lawyer

All medical professionals need to be able to bill properly, including dentists. When they use improper codes, it is unethical and can cause legal issues.

A Tampa dentistry license lawyer from The Law Offices of David P. Rankin, P.A. can help you with important transactions so you can keep your license. To schedule a consultation, call (813) 968-6633 or fill out the online form.