DentalCodeology: CDT 2015 shifts and dental coding tips every practice should know

The Code on Dental Procedures and Nomenclature (CDT) is generally thought to be used only for efficient processing of dental claims. This is true yet incomplete. Another purpose for CDT is to populate Electronic Health Records (EHR). This second purpose saw more light in the 2014 discussion of the Code Maintenance Committee (CMC) and changes were made for CDT 2015.

The existence of a code does not mean a patient has coverage under a policy. Yet without a code, no coverage could be offered. 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 provides us with the opportunity to measure outcome data.

Overview of CDT 2015 Updates

• 16 new procedure codes
• 52 revised procedure codes
• 5 deleted procedure codes
• Revised implant codes section with 8 new codes, 4 deleted codes and 10+ revised codes
• New codes for post-operative visits, sealant repair, evaluation for deep sedation or general anesthesia, and missed appointments

Diagnostic (D0100-D0999)

New codes were added to the diagnostic section for the re-evaluation of post-operative office visit and 3D photographic images. The added evaluation code D0171 that is meant to be used as for post-operative visits. The code will likely be subject to the evaluation frequency limitations.

Preventive (D1000-D1999)

In the Preventive section one code was added for sealant repair. Although the sealant repair code is helpful to accurately describe treatment, it will likely not be reimbursed as most sealants have a per tooth frequency limitation. Of greater interest is the revision of D1208 topical fluoride code to add the words-“excluding varnish.” Previously fluoride varnish could be submitted under either D1208 or D1206 though it is the role of the dental practice to use the most accurate code available. This change no longer gives the practice a choice.

It was once again submitted to the committee to add codes for different levels of prophylaxis. Once again, the committee decided this was not necessary. Similarly, the committee continues to vote “no” for a variety of laser-assisted periodontal therapy submissions. The given rationale is that since lasers are used in conjunction with other procedures, they could not identify how the submissions were different from procedures reported under current codes. Resubmissions to the committee include must new information not available when the original change request form was prepared.

Restorative (D2000-D2999), Endodontics (D3000-D3999) and Periodontics (D4000-D4999)

There were no new codes added for the Restorative, Endodontics and Periodontics sections. There were minor revisions in each section.

Implants (D6000-D6199) and Fixed Prosthodontics (D6200-D6999)

The greatest number of changes was in the D6000-D6199 Implant section with 27 revised, eight added, and four codes deleted. Practices submitting from this section should pay attention to the changes (see Box 2).

Removable and fixed implant or abutment-supported dentures now have codes that indicate either maxillary or mandibular arch. The previous code only indicated that an arch was involved not which one. The new codes also delineate the arch’s condition. Offices will need to know the condition of the indicated arch when selecting the proper code.

Maryland bridges that utilize resin-bonded retainers now have an appropriate code: D6549. Previously you could designate cast metal or porcelain retainers and use D6999 to indicate a resin retainer. The new code solves this problem.

New Sedation Evaluation Code
Offices that administer sedation now have a code for evaluation prior to the procedure D9219 evaluation for deep sedation or general anesthesia. This code takes into account that a provider other than the treating dentist may provide the anesthesia or sedation.

Adjunctive General Services (D9000-D9999)

Though there is no specific section for administrative code, two new codes were added to the Adjunctive Section for D9986 missed appointment and D9987 cancelled appointment after an extensive, robust discussion of the committee. This included a discussion of the need to add a new section for administration codes. These codes are needed for the requirements for administration in some states Medicaid. Some committee members questioned the need for these codes. Other members felt these measurements are important for continuity of care and electronic health records (EHR) coming forward.

Structured Data

As mentioned in the beginning, CDT is used to populate the electronic health record. EHR as well as the Affordable Care Act is moving our healthcare system toward more structured data gathering and evaluation. A standard EHR and interoperable national health information infrastructure requires the use of uniform health information standards, including a common language. Data must be collected and maintained in a standardized format using uniform definitions in order to link data within an EHR system or share health information with other systems. The lack of standards has been a key barrier to electronic connectivity in healthcare. Together, standard clinical terminologies and classifications represent a common medical language, allowing clinical data to be effectively utilized and shared among EHR systems. Neither a clinical terminology nor a classification can, by itself, serve all of the purposes for which health information is currently used or will be used in the future. CDT is one form of structured data.

“If coding is the same for everyone, or you think you already know the codes, you are not doing it right. To do it right, you must think and understand.”
-- Patti DiGangi and Christine Taxin