DentalCodeology: CDT 2014 shifts and coding tips that every dental practice should know

Creating codes to embrace new technologies, materials, and procedures can lead to earlier arrest and prevention of oral disease and positively influence systemic health. For the past decade, the CDT codes were updated every two years. To facilitate a fast-moving world, CDT is now updated every year. The existence of code does not mean a patient has coverage under a policy, yet without a code, no coverage could be offered.

How Many Codes Are Needed?

Part of the Affordable Care Act is aimed at improving the quality, efficiency, and overall value of health care. Reimbursements will be tied to outcomes in the future. Having a code gives opportunity to measure outcome data. CDT 2014 has changes in all 12 sections showing a shift with the addition of codes for regenerative procedures and stages of care.

Diagnostic

Three new caries risk assessments and documentation codes were added to CDT 2014. The description for all three codes: “Using recognized assessment tools.” Because the code contains the word documentation, writing the dental/medical necessity in this case the method of determining caries risk is needed.

These caries risk codes ARE NOT codes for specific treatments; they are to determine risk. They should be submitted in conjunction with other codes. The new codes are: D0601 caries risk assessment and documentation, with a finding of low risk, D0602 moderate risk and D0603 high risk. Reimbursement for these codes should not be expected since they do not describe actual provided treatment.

Diagnostic Imaging (formerly Radiographs) section contained the greatest number of changes in CDT 2013 particularly adding numerous codes for cone beam computed tomography (CBCT). This pattern was refined by adding more description to the codes plus adding new codes.  The new codes enable clinicians to describe the process of image capture, reconstruction and interpretation with more versatility than was previously available. CBCT images can assist in making a definitive diagnosis, help with treatment planning and follow-up care, and result in precise and favorable outcomes.

Preventive

There is always a code. It doesn’t sound right to many, but it is true. All 12 sections of CDT contained a fallback code D_999 unspecified __ procedure, by report as the last code in each section except in the Preventive Section. The new code D1999 unspecified preventive procedure, by report was added to CDT 2014.

Restorative

Atraumatic/alternative restorative treatment (ART) is a procedure involving the removal of soft, demineralized tooth tissue using hand instrument alone, followed by restoration of the tooth with an adhesive restorative material, routinely glass ionomer. ART is endorsed by the World Health Organization. Interim therapeutic restoration (ITR) more accurately reflects the procedure as practiced in the U.S. creating the need for the new code D2941 interim therapeutic restoration – primary dentition.

Crown buildup code D2950 was modified to express that the addition of coronal structure should not be used to eliminate undercuts, box cuts or concave irregularity. The new code D2949 more accurately describes the addition of foundational structure for the purposes listed above.

Endodontics

This section now has a subcategory to describe pulpal regeneration procedures. For offices that only had pulpal exposure, limited pulpal regeneration and apexification codes to choose from this new subcategory offers much more descriptive codes. This subcategory also includes descriptors that include bone grafting and biologic material so be careful to not confuse them with similar existing codes in the periodontal category.

Periodontics

Gingival irrigation is an important part periodontal therapy protocol in many offices yet there has not been a specific code. D4999 unspecified periodontal procedure was submitted more than 500,000 times in 2012. There has not been support of the code in the past by some code committee members because they question the clinical efficacy of one-time irrigation. Like many procedures in clinical practice, there is a gap between what science supports and what is routinely performed.

The National Dental-Practice Based Research Network is seeking close these gaps and to enroll more practitioners to contribute to their scientific endeavors. The new code is D4921 gingival irrigation – per quadrant is now available for practices using this therapy. This will help many offices who have been irrigating with chlorhexidine or another medicament but have never had a code to adequately describe the procedure.

Prosthodontics

Codes are not product-specific. Some procedures do not seem to have a code that accurately fits. An example of gaining an accurate code is for the minimally invasive procedure using Perio Protect trays. The Perio Protect Method tray is a prescription medical device that places medication in the sulcus or periodontal pocket.

Check out this product review: REVIEW: How Perio Protect offers a new way to treat perio

It is not co-packaged with any medication. It is simply an effective tool for subgingival delivery to address biofilm infections, inflammation, root caries or recession-induced sensitivity. The trays have customized seals and extensions fabricated along the interior periphery to prevent medication from leaking and provide positive pressure to direct medication deep into the sulcus and periodontal pocket. Perio Protect Method trays are classified as prescription medical devices, they require a doctor’s script and must be fabricated in a dental laboratory registered with FDA and trained by Perio Protect LLC.

The only code previously available for the procedure was D5991 topical medicament carrier which did not accurately describe the procedure. The new code is D5994 periodontal medicament carrier with peripheral seal – laboratory processed.

Implants

Offices have struggled for years with how to code mini-implants and finally we have a code that is appropriate. Previously mini-implants that were permanently placed were coded with D6010. However the price for a mini-implant is usually lower than the cost of a traditional implant. This was hard for offices to track so the addition of code D6013 to denote permanent placement of a mini-implant is very helpful. Don’t forget that any implant placed temporarily – regardless of size – is to be coded with D6012.

Offices who uncover implants after they have been placed at another office finally have a code to describe this procedure. Code D6011 describes the surgical access to an implant for placement of a healing cap or to prepare for abutment placement. Offices that were providing this service had no accurate code prior to 2014.

It is important to understand the revision of code D6080 implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prostheses and abutments. This code is NOT for routine prophylactic care of implant supported prostheses. It is for very specific complex situations. In order to use this code, the prostheses MUST be removed.  This is an important distinction as many offices previously used the code when several implants were present along with natural dentition.

Most significant change

The new sales tax code D9985 will not be a reimbursable code. However several states require dentists to charge sales tax on sales of items such as toothpaste, toothbrushes and mouthwashes. Check with your accountant to see if you are in one of the states that requires the reporting of such a tax.

What's the bottom line?

Staying current on coding is a continuous process. The American Dental Association plans to release and modify new codes every year and it will be up to each office to remain current. The use of outdated CDT codes on your claim forms can delay payment or even cause the denial of a claim.