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QUESTION: Our office has had some difficulty with filing a code for filling the endo access opening after the endodontist has completed the root canal. We have tried the one-surface composite code and it was rejected by all of the insurance carriers we sent it to. Then we tried the repair to crown code D2980. Is there a code for this procedure? Any information you could provide would be greatly appreciated. I tried doing an online search and was not able to find any useful information.
ANSWER FROM PATTI DiGANGI, BS, RDH, and LINDSEY HILL, BS, RDH, Beyond Oral Health.com:
A specific code for endodontic access repair has been submitted to the Code Maintenance Committee in the past. Their decision was that codes already exist for this. They include:
- D2140 amalgam—one surface, primary or permanent
- D2330 resin-based composite—one surface, anterior
- D2391 resin-based composite—one surface, posterior
- D2980 crown repair necessitated by restorative material failure
- D2981 crown repair necessitated by restorative material failure
- D2982 onlay repair necessitated by restorative material failure
- D2999 unspecified restorative procedure, by report
By report is italicized because D2999 code requires a report narrative. Though the other codes do not require a narrative, all submissions should include a short “Twitter-style” narrative in the Box 35 Remarks. The CDT 2020 Companion says a narrative should be written. It states, “This information is required when the diagnosis may affect claim adjudication when specific dental procedures may minimize the risks associated with the connection between the patient’s oral and systemic health conditions.”
Are there any dental procedures for which there isn’t a systemic effect? What was the stated reason for rejection of the D2330 code on the EOB? Claims are often auto-adjudicated, which means read by a computer algorithm. This is the preferred method for third-party carriers because it costs them $1 per claim versus $3 to $5 per claim when it’s read by a human. This is an area where artificial intelligence fails us.
The algorithms are written in order to bundle codes. Bundled endo codes can include the access closure, so there may not be specific coverage for this procedure.
Here’s the good news: when you take the time to write the personalized narrative to support submission, you have already done the work needed to support a challenge to coverage. A well-written medical necessity narrative does not need to be a long, ponderous message. I said “Twitter-style” because good writing removes extraneous and unnecessary content. There is a clear medical necessity for endo access closure. We hope this helps!
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