By Carol Tekavec, RDH
Effective Jan. 1, 2003, the ADA released its latest version of the Code on Dental Procedures and Nomenclature, CDT-4. The revised code includes 52 new codes, 40 codes with revised nomenclatures or revised descriptors, and the deletion of 27 codes. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), all dental offices and insurance carriers must use the current version of dental procedure codes as released by the ADA.
In the past, the ADA Council on Dental Benefit Programs updated treatment codes on a five-year basis. Now it appears that updates will occur every two years, making the next revision in 2005.
A few of the changes include:
D0180 — Comprehensive Periodontal Evaluation-New or Established Patient — New Code for C
This new code describes an assessment of a patient's periodontal condition as well as an evaluation of general dental health, caries, restorations, occlusal relationships, and oral cancer screening. It is believed that the Code Revision Committee intended this code to report a detailed periodontal evaluation performed on a patient with more than typical periodontal disease risk factors by either a general practitioner or specialist. It includes periodontal probing and charting, as does the long-standing code D0150-Comprehensive Oral Evaluation-New or Established Patient. (Keep in mind that there is still no separate code for perio probing and charting. Probing is considered to be a part of an exam/evaluation service). It is likely that D0180 will be reimbursed by carriers at the same rate as the D0150, which is usually once every three years.
D1110 — Prophylaxis, Adult — Revised definition for CDT-4
This code definition has been revised, stating that it is for "coronal scaling and/or polishing to remove coronal plaque, calculus, and stains." Previously, in the CDT-3, the definition stated "scaling and polishing," although it still listed "coronal" as the technical limit of the procedure. While the CDT-3 definition was incomplete in many respects, the CDT-4 version describes an even less technical procedure. At their February meeting, the Code Revision Committee "clarified the original intent" of the D1110 description.
A coronal polishing can be performed by dental assistants in many states and is typically not considered to be an adequate prophylactic service for most adults. There is still no ADA code that accurately describes the preventive and therapeutic procedure performed by dentists and hygienists for the majority of their patients; that is, scaling and polishing procedure to remove supra- and subgingival plaque, calculus, and stains from coronal and root surfaces, with or without the presence of localized gingivitis. Even though that is not what the code description says, it is believed that the ADA intends for code D1110 to apply to patients presenting with supra- and subgingival deposits as well as gingival inflammation, and expects offices to simply take more time and increase the fee as needed. Several incremental codes that could describe prophylactic procedures of a difficulty between the current description of a D1110 and a D4341 would be helpful. Currently there are no such codes.
D4910 — Periodontal Maintenance — Revised definition for CDT-4
The revised CDT-4 definition does not include any evaluations or examinations. (The 1990 CDT-1 included a dental examination as a part of the definition. The CDT-2 in 1995 did not include an examination. In 2000, the CDT-3 included a "periodontal evaluation" which was not clear as to whether that was a dentist's exam or data collection by a hygienist, and finally the 2003 CDT-4 with no mention of an exam). Periodontal maintenance is described as a procedure for patients who have previously been treated for periodontal disease including, among other services, removal of supra- and subgingival microbial flora or calculus and site-specific scaling and root planing.
Since an examination is not included in the code description, it is appropriate to charge out a separate fee for an exam, typically D0120-Periodic Oral Evaluation. Many carriers are expected to continue to provide a benefit for the D4910 code at a rate of two times annually, but not for an exam fee coded separately. A few carriers, such as Delta Dental of Massachusetts and Delta Dental of California, are reported to be considering patient contracts, allowing for a reduced fee for the D4910 but an additional fee allowed for a D0120 performed at the same time. This might mean that the patient would be receiving a similar monetary benefit as before, but for two codes instead of one. (Many carriers are also said to be contemplating a reimbursement rate of four times annually for D4910).
D4342 — Periodontal Scaling and Root Planing-One to Three Teeth, Per Quadrant — New Code
This new code describes scaling and root planing for a single tooth and up to three teeth in a quadrant. For example, #30 and #15 require root planing. The rest of the mouth needs a D1110. Code D4342 may be reported twice with the tooth numbers indicated on the claim form and the associated fee listed. A D1110 may also be reported. Perio probing depths and documentation of bleeding, recession, furcations, and/or mobility increase the likelihood of a benefit. D4342 will be very helpful for documenting an often-performed, but previously not adequately coded procedure.
Primary and Permanent Teeth – Amalgams — Revised Definitions-CDT-4
The differentiation between primary and permanent teeth for amalgam restorations has been eliminated. Codes D2110, D2120, D2130, and D2131 are gone. D2140, D2150, D2160, and D2161 have been revised to include primary or permanent teeth.
Posterior Resin-Based Composites — New Codes for CDT-4
The new codes now include both primary and permanent teeth. Former codes have been deleted. The new codes are D2391-Resin-Based Composite-One Surface, Posterior; D2392-Resin-Based Composite-Two Surfaces, Posterior; D2393-Resin-Based Composite-Three Surfaces, Posterior; and D2394-Resin-Based Composite-Four or More Surfaces, Posterior.
Codes for Extractions — New Codes for CDT-4
They are D7111-Coronal Remnants-Deciduous Tooth and D7140-Extraction, Erupted Tooth or Exposed Root. Previous codes (D7110-Single Tooth, D7120-Each Additional Tooth, and D7130-Root Removal) have been deleted.
D7287 — Cytology Sample Collection — New Code for CDT-4
This new code describes a "brush biopsy" technique as well as any other type of scraping to obtain an oral sample for analysis.
These are just a few of the new and revised codes from the CDT-4. Using current codes helps offices streamline paperwork and assists patients in receiving maximum benefits. Unlike previous updates, the CDT-4 codes will likely be incorporated into insurance computer systems quickly. HIPAA mandates require it. A few carriers have applied for code extensions until October of 2003. Some very small carriers have received extensions until October of 2004.
The ADA coding system is under the jurisdiction of the ADA. However, the revision process is a function of the Code Revision Committee that was formed in 2001 and represents both the ADA and the insurance industry.
Individual dentists may suggest code changes. Information about the process can be obtained at the ADA Web site — www.ada.org/goto/dentalcode.
Editor's Note: For information about Tekavec's updated coding manual featuring all of the coding changes, call (800) 548-2164 or visit www. steppingstonestosuccess.com.
Carol Tekavec, RDH, is the author of the Dental Insurance Coding Handbook Update CDT-4, and HIPAA basic forms; a "Notice of Privacy Practices" and an "Acknowledgement of Receipt of Notice of