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Washington State Dental Association

Reminder: ICD-10 Codes Implementation- Oct. 1, 2015

As of October 1, 2015, dentists along with individuals covered under the Health Insurance Portability and Accountability Act (HIPAA) will need to use ICD-10 codes when reporting diagnostic codes on claims. Dentists who treat Medicaid patients will likely see the greatest impact as the Health Care Authority (HCA), Washington’s Medicaid Administrator will be requiring providers to use ICD-10 codes when diagnostic codes are required in order to receive payment.  HCA has posted ICD-10 code equivalency mappings on their website. 

View the ICD-10 codes used for preoperative visits prior to performing a dental service under anesthesia. 

View the medically necessary ICD-10 codes required in order to bill with Expedited Prior Authorization for cleft palate procedures.

HCA will be conducting ICD-10 testing up until September 30, 2015 which will allow providers to submit test claims using ICD-10 codes. 

Please note that even if you do not treat Medicaid patients, you may be required to use ICD-10 codes in addition to a CDT code to obtain payment depending if there is a presence of a systemic condition that requires particular oral health services. For example, if a patient was diabetic they could be eligible for an additional prophylaxis through their dental plan. Claims for oral and maxillofacial surgery and/or anesthesiology services will require the updated diagnosis codes. 

In order to implement the ICD-10 codes, dentists who submit electronic claims may need to update their billing systems. Contact your practice management software vendors about the ICD-10 upgrades and make sure to familiarize your staff with the new completion instructions. Dentists who submit paper claims will need to make sure they are using updated claim forms. The ADA 2012 Dental Claim Form can accommodate ICD-10 diagnostic codes.  

For more information regarding the transition to ICD-10 codes, check out the resources below:


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