May 2019 Volume LIV Number 3


Behind the Code

ICD-10 Implementation Date was Oct. 1, 2015

November 2015 Volume L Number 6

After several implementation delays, ICD-10 diagnostic codes will be a mandate when filing dental claims for some commercial carriers and some state Medicaid plans. ICD-10 CM is the latest version of the disease classification used in the United States to record many types of health and vital records, including death certificates.
The primary purpose of ICD clinical modification codes is for epidemiological tracking of illness and injury. In health care, diagnosis codes are used as a tool to group and identify diseases, disorders and symptoms.
Dentists who participate in certain state Medicaid programs will no longer be able to use the ninth revision of the International Classification of Diseases to report diagnostic codes on their claims. Currently, the only state Medicaid programs that require diagnostic codes are Nevada and Arizona. ICD-10 diagnostic codes will be required when filing dental claims beginning Oct. 1, 2015, in these two states. Dentists should refer to their State Medicaid websites for more current and complete information on dental claims submission and diagnostic codes requirements.
State Medicaid programs that require ICD reporting want to capture clinical data to support public health activities, the development of evidence-based benefits plans and to efforts for increased funding. The ICD reporting is also required to facilitate payment for services related to the oral-systemic connection and coverage for additional dental services for certain medical conditions.
Dentists who do not take Medicaid patients may be required to use ICD in limited situations. Some commercial plans have identified specific dental procedures that may minimize the risks associated with the connection between the patient’s oral and systemic health conditions. These dental plans may provide additional benefits for conditions such as diabetes, pregnancy or heart conditions. Diagnosis codes will continue to be required for medical claims for oral and maxillofacial surgery and/or anesthesiology services.
Centers for Medicare and Medicaid Services (CMS) has created a helpful tool to find the appropriate ICD-10 code by typing in the diagnosis. For a quick reference for an ICD-9/ICD-10 equivalent, go to
To find all ICD-10 diagnostic codes under K00-K14 Diseases of oral cavity and salivary glands, go to
In addition, the 2016 AAPD Coding and Insurance Manual will include some cross coding examples specific to pediatric dentistry. The manual will be released early fall and will be announced on the AAPD coding and insurance page
For more information, please contact AAPD Dental Benefits Manager Mary Essling at or (312)
337-2169, ext. 36.

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