Decoding Dental Benefits: CDT codes
Jan. 1, 2018 marked the 49th year of the Code on Dental Procedures and Nomenclature.
Why a new version of the CDT?
So dentists can continue to accurately report what they do when new or revised procedures become part of dentistry.
“The CDT Code’s purpose is to achieve uniformity, consistency and specificity in accurately documenting dental treatment,” said Dr. Steven Snyder, chair of the ADA Council on Dental Benefit Programs. “Claim rejections and returns can happen for a number of reasons, frequently due to reporting the incorrect procedure.”
Dr. Snyder added that some CDT codes, especially recent additions, may not be readily understood. “The ADA has prepared a variety of publications and online references that address this educational need,” he said.
What does a dentist receive in return when submitting a claim with new or revised CDT codes instead of a deleted code? Dr. Snyder said one benefit is avoiding claim rejection, and thereby delayed reimbursement, caused by inaccurate procedure coding.
Let’s look at a hypothetical example of how rejection can happen.
“Suppose a patient has broken their resin base partial denture,” said Dr. Mark Mihalo, chair of CDBP’s Subcommittee on Coding and Transactions. “If a dentist was to complete and report the repair procedure in 2017, the applicable CDT 2017 code would be D5610 repair resin denture base. But what if the dentist reported the procedure in 2018 with the same CDT code? The claim would be rejected, because D5610 is no longer effective and has been replaced. The dentist’s choices would be either D5611 if the repair was to a mandibular resin base partial denture, or D5612 if the prosthesis was on the maxillary arch.”
Dr. Mihalo said, “The above example reflects a CDT Code change that enables more accurate reporting of the procedure delivered by noting the prosthesis’ location in the area of the oral cavity. There are other CDT 2018 changes that enable documentation of services that previously would be reported with a ‘999’ unspecified procedure by report code.”
One example of a new code is where the CDT Code now recognizes the increasing role dentists play in affecting a patient’s overall systemic health by determining the possibility of diabetes. The in-office procedure that identifies a patient’s average circulating blood sugar levels, hemoglobin A1c, is reported with D0411 HbA1c in-office point of service testing.
Another example are two new codes that address a nontraditional and growing mode for delivery of dental procedures: teledentistry. These codes are D9995 teledentistry – synchronous, real-time encounter and D9996 teledentistry – asynchronous, information stored and forwarded to dentist for subsequent review.
Notable CDT Code changes such as these may not be fully comprehended by dentists, practice staff and others in the dental community, Dr. Snyder said. In response to this educational need there are several code guidelines posted online, available for download at no cost at ADA.org/cdt. Look for the “Coding Education” link where there are the following guides, and more, that address CDT 2018 and earlier changes of note:
- D0411 – Guide to Point of Care Diabetes Testing (“finger prick”) Procedure and Reporting.
- C1354 – Guide to Interim Caries Arresting Medicament Application (aka Silver Diamine Fluoride).
- D9995 and D9996 – Guide to Understanding and Documenting Teledentistry Events.
- Guidance on the D4346 Scaling Procedure.
- Case Management Procedures (D9991-D9994).
Coding is also described in more detail at ADA.org/dentalbenefits, the ADA’s one-stop shop on dental benefits, and part of the ADA Center for Professional Success, which is located at Success.ADA.org. At the latter, search for “Frequent General Questions Regarding Dental Procedure Codes,” available only for member dentists.
Staff from the Center for Dental Benefits, Coding and Quality can help dentists with their coding and dental benefits-related problems, questions and concerns. Staff can be reached at 1-800-621-8099 or by email at firstname.lastname@example.org for coding and claim preparation questions or email@example.com for claims denial and third-party payer issues.
To order the CDT 2018: Dental Procedure Codes manual, CDT 2018 Companion: Help Guide for the Dental Team or CDT Code Check app, visit ADAcatalog.org or call 1-800-947-4746. Readers can save 15 percent on CDT 2018 and all ADA Catalog products with promo code 18100 until March 30.
If dentists have a concern or question they would like addressed in a future issue of ADA News, they can contact firstname.lastname@example.org.