The latest CDT update will become effective in January 2013, and it brings 35 new, 37 revised, and 12 deleted codes. A shift in the fluoride codes will affect your practice management system’s continuing care systems. Your traditional fluoride codes of D1203 (for primary dentition) and D1204 (for mixed and adult dentition) are no longer active. They are being replaced by code D1208 — topical application of fluoride. This one code is meant for use in primary, permanent, and mixed dentition.
Your practice management system most likely had a continuing care type attached to codes D1203 and D1204. These will need to be changed in your system to now attach to code D1208. I recommend that you find out if your software has the ability to make this a global change so that it attaches to all of your existing patients. Even if the software is able to make this change to your patient database, this does not necessarily mean that it will automatically change all existing appointments. You’ll need to check upcoming appointments to make sure that the correct code posts from your schedule onto the patient account.
Reimbursement will likely remain at the same level as the previous codes. Fluoride is usually classified as a preventive procedure and has frequency limitations of either one time per coverage year or once every 24 months. Some offices have reported fluoride coverage of once every six months. Keep in mind that treatment rendered should be according to diagnosis, not insurance benefits.
Insurance companies will most likely change the code for you if an old code slips through, but don’t count on that kind of service for more than a month or two. After that you’ll likely end up with unpaid codes or claims that won’t even leave your system because of the old codes. Please remember to check your claims submissions report to ensure that you catch all rejected claims.
The fluoride varnish code D1206 has remained in the code set, however, all descriptors regarding risk factors have been removed. This does not mean that you do not need to document any risk factors found during evaluation and medical history reviews. Your reasons for varnish use should always be easily recognized in your treatment notes.
By setting time aside now to make the changes in your codes you can avoid a slowdown in revenue later. For a complete listing of the 2013 codes, refer to the ADA’s CDT 2013 Dental Procedures Codes or Charles Blair’s Coding With Confidence manual. Also check with your practice management software for any downloads or updates to the system that include the new code set.
Teresa Duncan, MS, FADIA, FAADOM, is an international speaker who addresses topics such as Insurance Coding, Office Manager Training and Revenue Growth. Her company Odyssey Management, Inc. provides virtual, customized training in these areas. She can be reached at [email protected].
Editor's Note: The dental procedures codes ("Code") are owned and published by the American Dental Association ("ADA") in its reference manual Current Dental Terminology ("CDT"). The ADA is the exclusive owner and copyright holder of the CDT, including the Code, as well as of the ADA claim form.