September 2017 Volume LII Number 5

 
 
 
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Coding Corner: Common Coding Questions for CDT 2017

September 2017 Volume LII Number 5

The Code on Dental Procedures and Nomenclature (CDT) is updated annually. With these changes, there is a constant need to learn and understand new and evolving CDT codes. This article summarizes the common coding questions we received since the launch of CDT 2017.

D0600 Non-ionizing diagnostic procedure capable of quantifying, monitoring, and recording changes in struc- ture of enamel, dentin, and cementum

Q. Can any cavity detecting device or technique be used when report- ing D0600?


A. No. D0600 describes a non-ionizing diagnostic procedure for quantifying, monitoring, and recording changes in the structure of enamel, dentin, and cementum. The technology used for this diagnostic procedure must be capable of quantifying, monitoring, and recording changes in the structure of enamel, dentin, and cementum.

It is inappropriate to use this code to report traditional transillu- mination technology or techniques. A few examples of technology that are capable of providing this service are CariVu™, DIAGNO- cam, SOPROLIFE diagnostic camera, etc.

D4346 Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation

The removal of plaque, calculus and stains from supra- and subgin- gival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indi- cated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. Should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.

Q. What is the recommended fee for D4346?

A. There is currently limited fee data available for this new procedure code. Research shows that allowable reimbursements are highly flex- ible among payers for this new CDT code. Currently, the most com- mon reimbursement observed is comparable to D1110, with some charging 20 – 30 percent higher than D1110. AAPD always advises to confirm benefits prior to performing this service to help reduce financial surprises for both patients and in-network providers.

Q. Can D4346 be reported with one quadrant of D4342, periodontal scaling and root planning (SRP), when performed on the same service date?

A. The descriptor for D4346 states that there is an "absence of peri- odontitis" and the procedure "should not be reported in conjunc- tion with prophylaxis, scaling and root planing, or debridement procedures." Typically, reimbursement for any SRP procedure performed on the same service date as D4346 would be disallowed.

Q. Some plans are reimbursing D4346 as a periodontal benefit, ap- plicable to the plan deductible and periodontal reimbursement percentage. Can we report this procedure as a prophylaxis instead of using the new code?

A. No. You are required to report what you do, based on the diagnosis and documentation of the procedure performed, using the most specific CDT code from the current code set. This is true regardless of the benefit received or lack thereof. Reporting D1110 to receive or increase reimbursement is considered downcoding, a fraudulent billing practice.

D9994 Dental case management – patient education to improve oral health literacy

Individual, customized communication of information to assist the patient in making appropriate health decisions designed to improve oral health literacy, explained in a manner acknowledging eco- nomic circumstances and different cultural beliefs, values, attitudes, traditions and language preferences, and adopting information and services to these differences, which requires the expenditure of time and resources beyond that of an oral evaluation or case presentation.

Q. Is there a code to report and document interpretation services as required by Section 1557 of the Affordable Care Act?

A. Yes. CDT code D9994 may be used to document and report inter- pretation services.

Section 1557 of the ACA prevents dental practices from charg- ing a patient for interpretation services; however, it is important to document what you do. Case management efforts are sometimes required to be reported for federally funded programs in order to quantify case management efforts, such as interpretation services.

As always, report what you do. Select the appropriate CDT code from the current code set that best describes the procedure performed. It is important to fully read and understand the nomenclature and descriptor of CDT codes when selecting the proper code to report. A CDT code definition determines how a procedure is reported and supersedes any outside opinions and interpretations of the code.

Maintaining a current CDT coding manual and properly educating your dental team are key for successful coding. Gaining an understanding of proper reporting procedures can result in fewer denied claims and more timely manner for payment.

For more information, contact Dental Benefits Director Mary Essling at (312) 337-2169 or messling@aapd.org.

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