November 2018 Volume LIII Number 6

 
 
 
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Palliative Care

What is it and when should we code for it?

May 2012 Volume XLVIII Number 3

Palliative care is typically known to be something done to relieve pain or alleviate a problem without dealing with the underlying cause.

D9110 palliative (emergency) treatment of dental pain - minor procedure

This is typically reported on a per-visit basis for emergency treatment of dental pain.
 
CDT 2011-2012
The palliative treatment code may be one of the least understood and least used procedure codes in dentistry. Palliative treatment is not aimed at treating the root of the problem—palliative treatment is only intended to relieve the pain the problem causes. For example, if a patient presents swollen and in pain, and the doctor takes a radiograph, suctions the exudate from the molar area, writes one prescription for infection and another for pain, and then provides a referral for care or reschedules definitive care for another day, the doctor has delivered palliative care (suctioning exudate is a minor procedure), which can be coded as follows:

D0140 limited oral evaluation - problem focused
D0220 intraoral - periapical first film
D9110 palliative (emergency) treatment of dental pain - minor procedure


WHAT OTHER TREATMENTS MIGHT BE CONSIDERED PALLIATIVE?

 
Smoothing the sharp edge of a fractured tooth, placing ointment or medication on a minor laceration, or placing an ice pack after trauma are examples of treatment that fit the definition of palliative care. If the dentist does anything else that can be coded as delivering care, such as placement of a temporary crown, placement of an interim restoration, incision and drainage, or opening a tooth to establish drainage, then code for that procedure instead of D9110, which is considered to be a minor procedure and more general in nature.
 
Rarely does a patient come into a dental office when some type of care is not delivered. One reason D9110 is underutilized is that practitioners believe they have not done much when relieving pain that is not complicated or time-consuming. However, the cost of the dentist’s time, staff time, and asepsis adds up quickly even if palliative treatment is not complicated. Also, keep in mind that the Code on Dental Procedures and nomenclature exists to allow dentists to record everything they do. As we move further into the area of electronic health records, dental teams must get into the habit of recording everything they do. Coding for palliative care supports the doctor’s written narrative in the patient’s chart of the treatment that was rendered.
 

SOME COMMON QUESTIONS WE RECEIVE AT AAPD HEADQUARTERS


BILLING AN OPEN & BROACH


Q. Is there anything wrong with reporting palliative treatment (D9110) instead of D3221 (pulpal debridement) when performing
an open and broach on an emergency patient?

A. According to CDT 2011-2012 (p. 155), the CDT Companion (p. 95), and The Endodontists’ Guide to CDT (p. 28), an emergency open and broach procedure to relieve pain should be reported as pulpal debridement (D3221), which involves the removal of acutely inflamed pulp tissue.

D9110 was developed for reporting the relief of pain and typically does not have a therapeutic component. An open and broach commits a patient to having a root canal or an extraction, so there is a therapeutic component, which is why it is best coded as D3221. However, please note that the CDT description for D9110 does not specifically preclude it from being used to report an open and drain.


BILLING TIPS FOR D9110


DO:
  • Bill D9110 on a per-visit basis regardless of the number of procedures performed on the same date of service and always send a narrative describing the service rendered
  • Bill D9110 along with D9440 (office visit after regularly scheduled hours), when applicable, knowing that the patient will likely be responsible to pay for the after hours office visit out-of-pocket
DON’T:
  • Bill D9110 when only writing a prescription without performing a minor procedure to relieve pain
  • Bill D9110 if the patient’s chart notes do not specifically describe the minor procedure that was performed to relieve pain

DENTAL PLAN VARIATIONS


Although there is nothing in the language of D9110 that prevents one from reporting palliative treatment on the same day as a problem focused evaluation (D0140) or a separate unrelated procedure, some dental plans will not pay for D9110 when billed with any other diagnostic or definitive procedure.
 
For more information, please contact AAPD Dental Benefits Manager Mary Essling at (312) 337-2169 ormessling@aapd.org.