May 2019 Volume LIV Number 3


Coding Corner

May 2018 Volume LIII Number 3

Three New 2017/2018 CDT Code Guides

The ADA Council on Dental Benefit Pro- grams, with support from knowledge experts in the dental community and Practice Insti- tute staff, published three new 2017/2018 CDT code guides that cover teledentistry (D9995-D9996), the application of a caries- arresting medicament (e.g., silver diamine fluoride) (D1354), and finger-prick in-office diabetes testing (D0411). Each guide will help dentists understand the procedures underly- ing these CDT 2017/18 codes and how they should be reported.

These guides are available on the ADA’s Coding Education page at http://www.ada. org/en/publications/cdt/coding-education.

D9995 and D9996 – Guide to Understanding and Documenting Teledentistry Events

CDT 2018 marks the addition of codes for documenting and reporting the two types of teledentistry scenarios a dentist can play a part in – one where data is collected and addressed in real-time, and the other where data is collected, stored and forwarded to be addressed at another time and location.

Teledentistry provides the means for a patient in one physical location to receive services, and the dentist or other oral health or general health care practitioner overseeing the delivery of those services is in another lo- cation. This mode of patient care makes use of telecommunication technologies to convey health information and facilitate the delivery of dental services without the physical con- straints of a brick and mortar dental office.

ADA Guide to Understanding and Docu- menting Teledentistry Events is available at no cost for you to view or download at tions/Files/D9995andD9996_ADAGuidetoUnd- erstandingandDocumentingTeledentistryEvents_ v1_2017Jul17.pdf ?la=en.

D1354 – Guide to Interim Caries Arresting Medicament Application (aka Silver Diamine Fluoride)

CDT code D1354 has been in effect since Jan. 1, 2016. This guide addresses two notable aspects of the procedure and its code – first that the procedure is not limited to the application of Silver Diamine Fluoride (SDF) as the medicament; and second the clarifying revision that this procedure is to be reported by tooth treated, not by number of lesions.

In some parts of the dental community D1354 has been referred to as the SDF code, which is an understandable misperception as thismedicamentiswidelyused fortheproce- dure. The code’s nomenclature and descrip- tor are intentionally more broadly worded and inclusive. Find out why in the guide. Inside you will also find out about this code’s CDT 2018 revision, adding "…– per tooth" to its nomenclature so that the procedure is reported consistently.

ADA Guide to Reporting Interim Car- ies Arresting Medicament Application is available at no cost for you to view or download at ADA/Publications/Files/D1354_ADAGuideto- ReportingInterimCariesArrestingMedicamentAppli- cation_v1_2017Jul15.pdf ?la=en.

D0411 – Guide to Point of Care Diabetes Testing ("finger-prick") Procedure and Reporting

CDT 2018 marked the addition of "D0411 HbA1c in-office point of service test- ing" – a chair-side screening procedure that, alongwith appropriate referral, aids in the diagnosis of pre-diabetes and diabetes. This procedure, also known as finger-stick random capillary HbA1c glucose testing, is relevant to dentists as diabetes is a risk factor related to periodontal disease.

Hb1Ac testing enables a dentist to amend the patient’s treatment planning depending on whether the results are the first indicator of a new diabetic condition, or if the results indicate a change in the existing diabetic condition.

ADA Guide to Point of Care Diabetes Testing and Reporting is available at no cost for you to view or download at https://www. D0411_ADAGuidetoPointofCareDiabeteTestingan- dReporting_v1_2017Jul17.pdf ?la=en.

Questions about these guides, other cod- ing education material, or the CDT Code it- self should be directed to Director of Dental Benefit Programs Mary Essling, at messling@ or (312) 337-2169.

Another Win for Member Dentists

The Texas Dental Association and the Texas Academy of Pediatric Dentistry contacted AAPD in early 2018 regarding complaints about DentaQuest’s new restrictive policy that requires preauthorization for the use of D9248 non-intravenous conscious sedation. DentaQuest is the Texas State Medicaid Dental Program.

The explanation of benefits (EOB) language was confusing as it gave the impression that a dentist needed to document failure of nitrous before D9248 would be approved. In actuality, DentaQuest was looking for documentation on why oral conscious sedation was used versus nitrous.

AAPD staff reached out to the National Dental Director for Den- taQuest.

After a couple of conversations with the Dental Director, AAPD, TDA and TAPD staff and the AAPD Public Policy Advocate, the confusion was resolved. DentaQuest was in the process of revising the EOB language to clarify that nitrous is one of several criteria and not a requirement.

DentaQuest provided the following remarks:

DentaQuest is in the process of reviewing and revising its EOB denial language.

DQ’s internal criteria has not changed. The denial lan- guage includes the qualifiers which are also in the Office Refer- ence Manual. The only change was requiring prior authoriza- tion with appropriate documentation. Clinical denials since the change are low. However administrative denials are occurring as the doctor’s documentation, which was spelled out for them, has been incomplete or missing. We would suggest continuing to monitor the effects of the change.

AAPD believes that providing documentation of medical necessity is a legitimate function of a Medicaid dental program fiscal inter- mediary. The indications for all provided services should already be part of the patient record and so long as DentaQuest is not requiring anything more, the requirement is not unreasonable. We are told that if the narrative notes an appropriate reason/contraindication(s), per the AAPD Guideline which DentaQuest currently adheres to, Denta- Quest will pay the claim.

AAPD will continue to monitor this matter.

Dr. Bill Steinhauer, AAPD Texas Public Policy Advocate said, "The Texas Dental Association and the Texas Academy of Pediatric Dentistry had both found DentaQuest in Texas to be unsympathetic to their concerns about inappropriate denials of conscious sedation prior authorization requests. Once AAPD contacted Dr. Thommes there was an immediate turnaround within DentaQuest. Now the requests are being handled both expeditiously and appropriately."

Please feel free to contact Director of Dental Benefit Programs Mary Essling at or (312) 337-2169.

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