Let’s be honest…

Dental billing sometimes feels like trying to translate Shakespeare…
…written in hieroglyphics…
…while insurance companies grade your work with a red pen and a bad attitude.

Welcome to Correct Coding in Dentistry, where what you did and what gets paid are often two completely different stories.

The Great Translation Problem

Doctor finishes a procedure and writes in the clinical notes:

“RCT completed. Tooth restored.”

Simple. Clean. Accurate.

Meanwhile, your billing team is in the corner like:

“Okay… but what kind of restoration are we talking about here, doc?”

Was it:

• A core build-up?

• A crown prep?

• A crown replacement?

• A repair?

• Was 50% of the tooth gone?

• Did we just casually do crown lengthening and forget to mention it?

Because to insurance…
“we fixed it” is not a clinical note. It’s a mystery novel.

Your Billing Team: Part Detective, Part Mind Reader

Let’s give credit where it’s due.

Your billing team is expected to:

• Read your notes

• Interpret your intent

• Decode clinical shorthand

• Apply correct ADA codes

• Submit bulletproof claims

• And somehow predict what insurance will accept today

All without ever stepping foot in the operatory.

No pressure.

They’re basically expected to be:

• A fly on the wall

• A forensic analyst

• And a psychic

All rolled into one.

The Build-Up vs. Filling Showdown

One of the most common coding battlegrounds:

“It’s just a filling…” vs. “No, it’s a build-up.”

To a new assistant, or even a rushed note, it might look like the same thing.

But to insurance?

That difference could mean:

• Hundreds of dollars paid

• Or bundled into oblivion

And we all know how much insurance loves to bundle things like it’s a holiday sale at Costco.

“Please Provide Long-Term Prognosis”

Ah yes… the classic insurance request:

“Can you please provide the long-term prognosis of this tooth?”

Oh, you mean…
predict the future of a biological structure… inside a human… over decades?

Sure. Let me grab my crystal ball.

But here’s the truth:

If your documentation and coding don’t clearly support:

• Why the tooth needed treatment

• How much structure was lost

• What was done to restore it

Insurance will default to:

“We’re not convinced. Denied.”

The ADA Codebook: A Thriller Novel Nobody Asked For

Every year, the ADA updates codes.

Every year, your team collectively says:

“Wait… there’s a code for that now?!”

Especially with implants.

We’ve gone from:

“Place implant. Restore implant.”

To:

• Implant-supported what?

• Hybrid what?

• O-ring replaced on a what now?

And yes…
there is absolutely a code for changing that denture O-ring.

Will insurance pay for it?

Now we’re back to gambling.

The Real Cost of “Close Enough” Coding

Here’s where this gets serious.

Incorrect or vague coding doesn’t just cause denials.

It leads to:

• Downcoding

• Bundling

• Lost revenue

• Increased audits

• Team burnout

And worst of all…

You end up getting paid based on what insurance thinks you did…
instead of what you actually did.

The Veritas Truth

At Veritas Dental Resources, we say this all the time:

“You don’t have a production problem… you have a translation problem.”

Correct coding is how you:

• Protect your clinical decisions

• Communicate your value

• And get paid what you’re worth

Because if it’s not documented…
and it’s not coded correctly…

To insurance?

It didn’t happen.

Final Thought: Close the Gap

Doctor, your hands do incredible work.

But your notes and coding are what get that work recognized.

So let’s close the gap between:

• What happens in the chair

• And what shows up on the EOB

Because when your clinical excellence is matched with coding precision…

That’s when everything changes.

Quick Recap

• Your billing team isn’t in the operatory, documentation must tell the full story

• Small coding differences like build-up vs filling create big revenue impact

• Insurance requires clarity, not assumptions

• ADA codes evolve, your team must evolve with them

• Correct coding means getting paid for what you actually did

If this hit a little too close to home… good.

Because fixing this doesn’t require working harder.

It requires working smarter, clearer, and more strategically.

And that’s a game worth winning.

Jody Lujan
Client Success Architect - Veritas Dental Resources
📞 888-808-4513
Services: PPO Fee Negotiators, PPO Fee Negotiating, Insurance Fee Negotiating, Insurance Credentialing, Insurance Verifications
Websites: www.VeritasDentalResources.com, www.VerusDental.com