May 2019 Volume LIV Number 3

 
 
 
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Behind the Code CDT 2015 Deletions and Revisions PART TWO OF CDT 2015

July 2015 Volume L Number 4

 The following CDT pediatric dental codes have been deleted from CDT 2015. Do not report these codes for services delivered on or after Jan. 1, 2015.

D6975 Coping To be used as a definitive restoration when coping is an integral part of a fixed prosthesis.

Rationale for deleting D6975: D6975 was deleted and D2975 revised in an effort to eliminate redundant codes. D2975 can be used to report a coping that can serve as a definitive restoration, which may be an integral part of a removable or fixed prosthesis. This deletion is akin to the previous deletion of several other fixed prosthodontics codes that duplicated restorative codes (i.e., D6970, D6972, D6973, D6976, and D6977).

 

Sixteen New Codes Introduced in CDT 2015

D0171 Re-evaluation — post-operative office visit

Rationale for adding D0171: Until now, there has been no specific CDT code to report the re-evaluation at a postoperative office visit. D0170 limited, problem focused (established patient; not post-operative visit) could not be reported because its nomenclature specifically states that it is not to be used as a post-operative code. If reimbursed, this service will count toward the plan's frequency limitation related to the number of oral evaluations allowed per plan year.

A typical coding scenario for D0171 involves a patient who returns after a surgical (i.e., graft) or operative (i.e., restoration) procedure for the dentist to evaluate his/her healing and determine whether further observation or additional services are needed. This visit does not immediately follow the procedures.

D0171 may be used to document the re-evaluation of a patient four to six weeks after periodontal scaling and root planing. However, most payers include follow-up evaluations in the global procedure fee. 

Note that D0180 may be more appropriate and may have a higher reimbursement than D0171 in this case.

Note: A dentist, not a hygienist, should perform this oral evaluation

 

D0351 3D photographic image

This procedure is for dental or maxillofacial diagnostic purposes. Not applicable for a CAD-CAM procedure.

Rationale for adding D0351: 3D visible light images are used independently or in conjunction with other diagnostic modalities for D0393 (treatment simulation using 3D image volume) or D0395 (fusion of two or more 3D image volumes of one or more modalities). They may also substitute images made using ionizing radiation for evaluation of facial appearance over time, such as following orthodontic or orthognathic treatment.

D0351 can be used to document a dimensionally accurate 3D photographic intraoral or extraoral image constructed by the integration of multiple photographic images or a laser scan. Until now, D0350 (oral/facial photographic image) has not been limited to 2D images. Effective January 1, 2015, D0350 has been revised to only include 2D images as a result of the addition of D0351 for 3D photographic images.

 

D1353 Sealant repair — per tooth

AAPD submitted this proposal to the Code Maintenance Committee (CMC) for review.

Rationale for adding D1353: According to the American Academy of Pediatric Dentistry (AAPD), sealant maintenance and repair are an essential part of an effective caries control protocol for susceptible teeth. "Dental sealants may fail completely (i.e., no sealant material remains bonded to the tooth surface), but most fail incrementally, with partial loss of sealant material. When either occurs, reapplication of sealant material to the unprotected, caries susceptible pits and fissures is indicated."

This is consistent with accepted clinical sealant guidelines, including that of the AAPD, which states that sealant maintenance or repair is a clinical procedure  distinct from initial sealant placement. Therefore, this procedure should be coded separately so that the clinical record remains accurate.

Electronic health records (EHR) necessitate that dentists have a method to document the services they perform whether dental plans provide a benefit or not. Some payers think the sealant code (D1351) should be reported whether a sealant is repaired or replaced since frequency limits will apply either way. Although many dentists tend not to charge for repairing sealants within a given time frame, the CMC determined that it is important to have a specific code that accurately documents the procedure performed. D1353 provides a way for dentists to document and track sealant repairs separately from new sealants in their practice management system even if they repair them free of charge. This new code will also allow dentists to track sealant repairs without disturbing UCR fee data for D1351.

For example, D1353 should be reported if one year after placing dental sealants on the occlusal surfaces of the patient's four first permanent molars, a clinical examination reveals that part of the sealant material bonded to the maxillary right first molar has been lost. The pits and fissures are exposed to bacteria, oral fluids, and sugars. The tooth is isolated, existing sealant material that is not wellbonded is removed, the enamel surface is conditioned by acid etching, and the new sealant material is applied to the pits and fissures.

 

D6549 Resin retainer — for resin bonded fixed prosthesis

Rationale for adding D6549: The addition of D6549 fills a significant void in CDT. D6545 is used to report a cast metal retainer on a resin bonded fixed prosthesis (Maryland bridge). D6548 is used to report a porcelain/ceramic Maryland bridge retainer. However, CDT has provided no specific code for reporting a resin retainer for a Maryland bridge. Previously, dentists have been forced to report an unspecified code (D6999), which many dental plans do not consider for payment. (Maryland bridge pontics are coded separately using the appropriate material code from CDT's Fixed Partial Denture Pontics subcategory.)

A typical coding scenario for D6549 involves a patient who presents with a missing tooth, but is not a candidate for a single crown implant restorative prosthesis or a conventional fixed bridge (for a variety of possible reasons). The dentist determines that the patient's need for a single unit fixed prosthesis may be met by preparation and placement of a Maryland bridge where both the pontic and "wings" (retainers) are resin materials.

Effective Jan. 1, 2015, each Maryland bridge resin retainer may be reported as D6549. The resin pontic will be coded as D6205 (pontic indirect resin based composite). With regard to fees, each Maryland bridge retainer "wing" is typically billed at approximately 50 to 75 percent of the pontic fee.

For example: #8 D6549 at $400, #9 D6205 at $800, and #10 D6549 at $400. Total cost: $1,600.

Third-party payment may be influenced by the following: the patient's remaining maximum, waiting periods for major services, prosthetic replacement limits, a missing tooth clause, plan exclusions for certain prosthetic services, and/or a least expensive alternate treatment (LEAT) clause if the patient has more than one tooth missing in the arch.

 

D9219 Evaluation for deep sedation or general anesthesia

Rationale for adding D9219: The addition of a CDT code for evaluation for deep sedation or general anesthesia complies with guidance prepared for clinicians in the ADA's "Guidelines for the Use of Sedation and Anesthesia by Dentists," which was adopted by the ADA House of Delegates in October 2012.

These guidelines state that "...patients considered for deep sedation or general anesthesia must be suitably evaluated prior to the start of any sedative procedure. In healthy or medically stable individuals (American Society of Anesthesiologists [ASA] I or II) this must  consist of at least a review of their current medical history, medication use, and NPO status. However, patients with significant medical considerations (i.e., ASA III or IV) may require consultation with their primary care physician or consulting medical specialist." The same guidelines define the term "must" as "indicates an imperative need and/or duty; an essential or indispensable item."

Although some argue that the pre-anesthesia evaluation is part of D9220, the descriptor for D9220 states that anesthesia begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive monitoring protocol, and remains in continuous attendance of the patient. It does not refer to any evaluation that occurs prior to the administration of the anesthetic. Because of this, the CMC considers this essential evaluation to be separate from existing deep sedation/anesthesia procedure codes (D9220/D9221).

Furthermore, if the anesthesiologist is a separate provider, a preexisting relationship with the patient is not likely. Additional time would be needed before the procedure to review the patient's chart and medical history.

 

D9931 Cleaning and inspection of a removable appliance

This procedure does not include any required adjustments.

 

Rationale for adding D9931: This new code fills a void in CDT since there has been no specific CDT code for reporting the cleaning and inspection of a removable appliance. (The codes for adjustments to complete or partial dentures, D5410, D5411, D5421, and D5422, do not address cleaning procedures.) The ADA's Council on Dental Benefit Programs (CDBP) requested this new code for the cleaning and inspection of a full or partial removable denture during the CDT 2015 code cycle. Past code revision committees have instructed dentists to report D1110, which caused considerable confusion.

A previous new code request, submitted for consideration in 2010, was not accepted into CDT because a committee member representing a major dental benefit company asserted that the existing  adult prophylaxis code (D1110) could be used to document denture cleaning and maintenance. This was not the case.

In January 2013, the Council on Dental Benefit Programs became aware that the same dental benefit payer would not provide a benefit because D1110, as described in CDT, states removal of plaque, calculus, and stains from the tooth structure of permanent or transitional dentition. The payer interpreted this to mean natural teeth, not denture teeth. Furthermore, D1110's descriptor states that the prophylaxis procedure is intended to control local irritational factors, which is specific to natural teeth and their supporting structures. The dental benefit payer concluded that this precludes D1110's application to prosthesis maintenance (contrary to the committee member's prior testimony).

In addition, there is a precedent for including a code for the inspection and maintenance of a prosthesis. D6080 specifically addresses implant maintenance procedures that include fixed prosthesis removal, cleaning, and reinsertion. D5993 specifically addresses the maintenance and cleaning of maxillofacial prostheses.

As a result, D9931 will now be used to report the cleaning and inspection of partial or complete dentures worn by patients who have accumulated calculus and other foreign materials that they cannot safely remove themselves. For example, a patient presents with hardened calculus on the denture, which is removed by ultrasonic cleaner and/or dental hand instrumentation. As this new code is currently written, it could also be used to report the cleaning and inspection of other removable appliances such as night guards, orthodontic retainers, overdentures, or partial dentures. Payers may require verification that this procedure is performed by a dentist (i.e., inspection by a dentist), rather than an office staff person simply putting an appliance in an ultrasonic cleaner. The clinical notes should clearly state that the dentist inspected the appliance and recommended D9931 be performed. Then, it should be stated that the cleaning procedure was actually performed either by a dentist or a dental team member. 

Also note that the CMC vote included the recommendation that D9931 be placed in the Adjunctive General Services category.

 

D9986 Missed appointment

Rationale for adding D9986: Dental teams may be surprised to learn that CDT 2015 is introducing a new code for missed appointments. Although the CMS asserts that it is illegal to charge for missed appointments and those cancelled without sufficient notice, the Code Maintenance Committee decided that dentists could benefit from having a way to electronically document (and track) when patients miss their appointments. According to the National Association of Dental Plans' CDT Workgroup, a missed appointment code is needed for compliance with certain state and federally funded programs and is needed to allow the electronic health record to accurately reflect patient behavior related to dental care.

A patient who does not arrive for scheduled care adds to the cost of dental care because both administrative staff and clinical staff must prepare for delivery of the scheduled services prior to the patient's arrival. Plus, there is a loss of production. Patients who miss appointments undermine both the efficiency and productivity of the entire dental team. And yet, until now there has been no specific CDT code for reporting a missed appointment, whether a provider intends to charge the patient or not. This new CDT code, D9986, will allow a provider to document and easily track the practice's inability to provide services when a patient fails to attend a scheduled appointment.

Although patients who arrive late for their appointments also have a significant effect on patient care and practice efficiency, the CMC denied a request for a new code to document a patient's late arrival. This code was denied because the CMC felt that this level of documentation was not needed. Many dentists would like a late 

 

D9987 Cancelled appointment

Rationale for adding D9987: CDT has multiple purposes. CDT codes are essential for accurate documentation of administrative actions in the dental office, in addition to insurance claim submissions. Tracking cancelled appointments is important for the establishment of continuity of care and thorough documentation in the patient's electronic health record. The addition of the two new administrative codes, D9986 and D9987, will be particularly helpful for identifying and tracking patients who frequently miss and/or cancel appointments. Dental plans do not provide a benefit for broken appointments or cancellations without adequate notice. However, documenting a broken, cancelled, or late appointment on a patient's billing statement may improve compliance, even when no fee is assessed. 

Interestingly, it was the National Association of Dental Plans' CDT Workgroup that requested this new administrative based code. They stated that the code is needed for compliance with certain state and federally funded programs and to allow the electronic health record to accurately reflect patient behavior related to dental care. Having a code would allow a provider to document when services are not provided due a cancelled appointment. This may also help providers track patients who have not rescheduled their appointments following cancellations.

As currently written, D9987 may be used to document a patient who cancels a previously scheduled appointment without adequate notice (creating an unanticipated void in the provider's schedule), to track a patient who cancels an appointment without rescheduling, or to simply document in the patient's electronic record that an appointment was cancelled. 

arrival code for electronic health records documentation and tracking purposes, which is an equally important function of CDT. 

In conclusion, it is critical that dentists stay well-informed of changes in current dental coding terminology. Understanding all current CDT codes can improve your dental coding and insurance claim submissions and facilitate your practice to increase more timely payment on claims.

For further information, please contact AAPD Dental Benefits Manager Mary Essling at (312) 337-2169 or messling@aapd.org.  

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