New procedure codes and updated fees for 2011-2012

March 7, 2011
This year has brought some rather unique, as well as potentially troublesome, issues and challenges with the redefinition of and changes to dental procedure codes. Tom Limoli systematically steps through the various clinical dentistry categories and explains the updates you need to know about.
Editor's note: Reprinted with permission from McKenzie Management e-newsletter.

By Tom Limoli
2011 has already brought about some rather unique, as well as potentially troublesome, issues and challenges with redefined and new changes to the Codes on Dental Procedure and Nomenclature. Let’s take a look into the future and briefly see what is in store over the next two years. Current Dental Terminology is available directly from the American Dental Association, as well as through my Dental Insurance and Reimbursement — Coding and Claim Submission Manual.Redefined terminologyDiagnostic — Unless you own or are employed by a pathology laboratory, the redefinition of D0486, once again, is going to have absolutely no impact on your day-to-day life. Restorative — What was a sedative filling is still D2940, but it is now called a “protective restoration.” The descriptor is somewhat improved, but it now contradicts D9110 while at the same time specifying its previous inappropriate usage for closing an endodontic access hole.Endodontics — D3351 and D3352 apexification/recalcification codes have been clarified to more specifically address the interrelationship with new code D3354 pulpal regeneration, so as to avoid confusion concerning appropriate use. More on code D3354 will come later. Periodontics — D4263 and D4264 bone replacement grafts, D4266 and D4267 guided tissue regeneration, and D4320 and D4321 provisional splinting all have grammatical as well as technique-sensitive corrections in the descriptors. Implant services — Existing code D6055 implant connecting bar can now be used for both implant or abutment-supported bars, while D6950 precision attachment specifies that it is identified separately from the prosthetic. Oral and maxillofacial surgery — Thankfully, D7210 surgical extraction still requires removal of bone and/or sectioning of the tooth, but now the mucoperiosteal flap is no longer required, while D7953 bone replacement for ridge preservation and D7960 frenulectomy, frenectomy, and frenotomy have well-needed updated descriptors. Adjunctive — Of confusion is the redefinition of local anesthesia D9215, indicating its potential submission on benefit claims with both operative as well as surgical procedures. The future of the electronic health record notwithstanding, how many operative and surgical procedures are you doing without at least local anesthesia? This has the administrative nightmare of CDT-2005 written all over it. Have we not learned from the past? And now, to top it all off, analgesia D9230 was redefined by simply reversing the order of the words in order to pacify Sister Mary Mucknfutz, my 4th grade English composition teacher, while D9420 now includes visits to ambulatory surgical centers as well as hospitals. What a relief ...New terminologyPreventive — Preventive resin restorations in a permanent tooth will fall, or fail, under new code D1352. It does nothing more than simply identify when a sealant is still a sealant, but can now be classified as being a “super sealant.” I will stand my ground and share with you today my personal observation that this ill-intended and poorly designed CDT procedure code has the potential for health-care fraud and inappropriate utilization abuse written all over it.Endodontics — In the endodontic section, code D3354 will be used for regenerating the damaged pulp of a necrotic, as opposed to neurotic, immature permanent tooth. Maxillofacial prosthetics — Want to see an emotionally challenged and previously hopeless patient’s life change right before your eyes? Go back and give back to both the art and science of dentistry and spend some time with the artisans we all know as the maxillofacial prosthodontist. New code D5952 will be for adjusting a prosthetic appliance identified in the “D5900” section of the code. Also at their disposal will be D5993, which identifies the cleaning and maintenance of those same appliances found in the “D5900” section of the code. These codes are not intended to identify the simple adjusting and cleaning of traditional full or partial dentures. Prosthodontics, fixed — In the fixed partial denture section, codes D6254 and D6795 can be used for identifying interim bridges when not entirely part of routine prosthetic services. As with any interim appliance, its intention is strictly to maintain the patient while healing, resolution, and other procedures are being completed. Oral and maxillofacial surgery — New to the oral surgery section is D7251 for identifying the intentional removal of only a portion of a tooth so as not to create a neurovascular complication, while D7295 is for identifying only the harvesting of bone when it is going to be used in an autogenous grafting procedure.Fee dataIn updating your fees for 2011, take care and please do not trap yourself by attempting to establish your office fee schedule based on what some third-party payer reimburses at 65% of the 85th percentile. And don’t establish your fees based on the dentist down the hall or across the street. Your fees should be based on your overhead, expenses, patient base, and your individual level of professional expertise. Author bioTom Limoli is the prevailing expert on proper coding and administration of dental insurance benefit claims. He serves as president of Limoli and Associates/Atlanta Dental Consultants, Inc., a company that has assisted dental offices in streamlining the insurance reimbursement process over the past quarter of a century. Please visit for more information.