• Dentists chew over competing diagnostic code sets for EHR use

    Author | Date December 10, 2012
    While the medical field wrestles with the ICD-10 transition, slated for October 1, 2014, dentists are struggling with their own diagnostic code conundrum: the lack of an acceptable standard to track patient issues and report clinical outcomes.  As dentists implement EHR systems and hope to qualify for government meaningful use incentives, the availability of a standardized code set will become increasingly important as clinical quality measures take on a larger role in attestation requirements.  Currently there is no standard, but two competing systems are attempting to change that.
    Although dentistry has the CDT (Current Dental Terminology) for use in billing and benefits reporting, there is no diagnostic code set.  “We’re behind medicine by a lot,” Joel White, DDS, MS, an applied dental scientist and professor at the UCSF School of Dentistry told DrBicuspid.com. “Back in the days of the bubonic plague, medicine captured why people die. We don’t capture why teeth die. We’re centuries behind.”  Dr. White is a member of an international academic workgroup behind the EZCodes Dental Diagnostic Terminology, a set of 1,358 terms describing abnormalities and diseases in much the way the ICD codes do for medicine.  Dr. White envisions that EZCodes will help collect clinical data for research and public health uses.
    “We need to be diagnostic-centric. Once we really implement our diagnostic charts, we are really understanding how the patient is doing. We can really think about evidence-based care. We can think about reporting the data consistently and determining cost-effectiveness and efficiencies,” Dr. Elsbeth Kalenderian, DDS, MPH said.  She is the chair of oral health policy and epidemiology at the Harvard School of Dental Medicine, and one of the chief academics involved in EZCode’s development.  The EZCodes project began in 2009 and has received funding from the National Library of Medicine and the National Institute of Dental and Craniofacial Research.  EZCodes are being piloted in 17 dental schools across the United States and in Europe.
    However, EZCodes isn’t the only code set on the horizon.  Since the 1990s, the American Dental Association has been working on a subdivision of SNOMED, one of the standard reporting systems in medicine, called SNODENT, the Systemized Nomenclature of Dentistry.  With over 7000 codes, SNODENT provides more specificity than EZCodes, but has not yet seen the light of day.  An original release date of January 2000 has come and gone, and SNODENT is still more or less theoretical in 2012.
    While the ADA endorsement leaves many dentists looking at SNODENT as the standard they wish to adopt, and the ADA itself believes that the two standards can live side by side as two different interfaces, the HITECH Act thinks differently.  Eventually, the Department of Health and Human Services (HHS) will need to pick one or the other in order to achieve its goal of having a unified, interoperable standard.  Right now, dentists are unsure which way to turn, knowing that the wrong choice will leave them investing in equipment, education, and software that will be rendered obsolete if HHS chooses the competing standard.
    “Right now, there is no perfect system,” says Air Force Col. Paul Nawiesniak, chief dental officer at the Defense Health Information Management System.  He oversees the dental records of 3.5 million service members, and believes that a commonly accepted standard is urgently needed as EHR use rapidly increases.  “I haven’t touched SNODENT in seven years, but EZCodes is a new product, still in its infancy.   We are moving into an EHR universe,” Nawiesniak said. “You can do a lot of things on paper you can’t get away with electronically. Whether it’s ICD-9 or SNODENT or [EZCodes], we need to make a decision.”
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