Dental coding with Kyle: Occlusal guards

Dental coding can cause a lot of headaches in dental practices, especially when the codes are updated. Staying up-to-date can be hard. Here's a code change for 2019.

Jan 18th, 2019
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The reasons for determining insurance coverage and non-coverage have not changed, but the CDT codes have.

Out with the old CDT code!

D9940 Occlusal guard, by report

In with the new CDT codes!

• D9944 Occlusal guard–Hard appliance, full arch
• D9945 Occlusal guard–Soft appliance
• D9946 Occlusal guard–Hard appliance, partial arch

The reasons that insurance companies may cover include:

• Some plans will provide a benefit for a patient suffering the effects of bruxism.
• Some plans will provide a benefit for an occlusal guard, but only if the patient has a six-month prior to fabrication history of periodontal treatment, such as scaling and root planing and osseous surgery.

The reasons insurance companies may deny include:

• Failure to use one of the new 2019 CDT codes listed above
• Failure to indicate on the ADA claim form the reason for fabrication of the appliance
• Annual maximum has been absorbed
• Frequency and limitations play an important role in coverage. Be sure to find out if the patient has a fabrication history of an occlusal guard appliance.

Always keep in mind that it is recommended the office send in a pretreatment authorization, which includes radiographs and periodontal charting, to ensure a smooth claim determination process.

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