** See new comments below.

Original Post
A common question for me is whether or not dentists qualify as acceptable specialty types for risk adjustment. The answer is that only a subset of dentists – namely, Oral Surgeons (CMS specialty type 19) are acceptable sub-specialists from within the dentistry field.

Oral Surgeons are most typically dentists (DDS or DMD) with advanced training in oral-maxillofacial surgery (OMFS).

Specialists in this field handle all things related to head, skull, neck, jaw, teeth whether it be cleft palate reconstruction, facial reconstruction after trauma, dental implants or cancer-related head and neck surgeries.

So, only dentists who designate themselves in the documentation as providers in Oral Surgery or Oral Maxillofacial Surgery are acceptable dental sub-specialists from which you may obtain ICD-9 codes for risk adjustment.

** Addendum 7/21/2011.
Please see Comment #1 for correction. Thanks mistmi01! Oral Surgeons will map to CMS specialty code 19 (maps to NUCC Taxonomy code 1223S0112X), while standard Dentists must designate themselves as CMS specialty code 99 “Unknown Physician Specialty” when they apply for Medicare privileges. So, all dentists are acceptable sources for risk adjustment. Health plans may use NUCC taxonomy codes to distinguish dentists from oral surgeons. The NUCC code for a standard dentist is 122300000X. Oral Surgeons treat a broader number of conditions that are in the risk adjustment model.

1 Comment

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  By mistmi01, July 21, 2011 @ 9:39 AM

  All dentists are physicians under Medicare law (SSA 1861(r)1). Like all limited license practitioners, coverage of their services under Medicare is driven both by their scope of practice, and Medicare coverage guidelines. For risk adjustment purposes, they don’t have to be oral surgeons or oral maxillofacial surgeons, they just have to perform a service covered by Medicare–Medicare covers dental services that are an integral part of either a covered procedure (i.e., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Medicare also covers oral examinations,
  but not treatment, preceding kidney transplantation or heart valve replacement, under certain circumstances.

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