May 2019 Volume LIV Number 3

 
 
 
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Coding Corner

March 2019 Volume LIV Number 2

CDT 2019 Revisions
 
The ADA’s Code Maintenance Commit- tee (CMC) is responsible for maintaining the Code on Dental Procedures and Terminol- ogy (CDT) code set. The committee meets annually to review that year’s submitted change requests and votes to accept, amend, or decline each request based on the best in- terests of the profession, patients, and payers. The CDT 2019 meeting was held on March 15 –16, 2018. The CMC added 15 codes, revised five codes, deleted four codes, and made two editorial changes to the code set. The 2019 CDT code set became effective on Jan. 1, 2019. This article will review the new, revised and deleted codes that only pertain to pediatric dentistry.
 
NEW 2019 CDT CODES
 
D0412 Blood glucose level test – in-office using a glucose meter
This procedure provides an immediate find- ing of a patient’s blood glucose level at the time of sample collection for the point-of- service analysis.
 
Rationale for D0412: Diabetes is one of the most common chronic diseases. Therefore, dentists are likely to encounter patients with the disease. It is essential to know a diabetic patient’s blood sugar level before beginning a long, complex procedure. Even though the patient’s A1C may be at an acceptable con- trol level, his actual blood sugar level at that moment could be very low and, even worse, heading toward a hypoglycemic event.
 
If a patient’s blood sugar level is too low, the procedure should not be initiated because a hypoglycemic event is likely to occur during the procedure. Moving forward with the pro- cedure could put the patient at great risk. On the other hand, if the patient’s current blood sugar level is very high, even though their A1C level is at an acceptable percentage, an elective surgical procedure should be avoided at that time. A high level of blood glucose could lead to delayed healing of the surgical site and severe infection.
 
Current blood sugar levels cannot be obtained from an A1C test; you must use a glucometer. Glucometer testing can also be used to test individuals who have risk factors for diabetes, but who have not been diag- nosed with either pre-diabetes or diabetes.
 
The findings must be documented in the patient’s record and provided to the patient. An appropriate medical referral should be made, as needed.
 
D1516 Space maintainer – fixed –
bilateral, maxillary
D1517 Space maintainer – fixed –
bilateral, mandibular
Rationale for D1516 and D1517: Current CDT code D1515 is not specific as to which arch is involved in the treatment. Therefore, numerous claims are submitted with two code D1515s – one for each arch. This often leads to a request for additional information so that the payer can determine if submission of two D1515s was an error or if it was performed on both arches.
 
CDT 2019 implements D1516 and D1517 to specifically identify the arch treated, allowing the claim to be auto-adjudicated. Addition- ally, this prevents a request for additional information and can decrease reimbursement time.
 
D1526 Space maintainer – remov- able – bilateral, maxillary
D1527 Space maintainer – remov- able – bilateral, mandibular
Rationale for D1526 and D1527: Current CDT code D1525 is not specific as to which arch is involved in the treatment. Therefore, numerous claims are submitted with two code D1525s – one for each arch. This often leads to a request for additional information so that the payer can determine if submission of two D1525s was an error or if it was performed on both arches.
 
CDT 2019 implements D1526 and D1527 to specifically identify the arch treated, allowing the claim to be auto-adjudicated. Addition- ally, this prevents a request for additional information and can decrease reimbursement time.
 
D9613 Infiltration of sustained release therapeutic drug – single or multiple sites
Infiltration of a sustained release pharmaco- logic agent for long acting surgical site pain control. Not for local anesthesia purposes.
 
Rationale for D9613: During our nation’s current "opioid crisis," patients are request- ing non-narcotic alternatives for post- operative pain control more frequently. In response, doctors are utilizing a sustained release pharmacologic agent infiltrated at the surgical site to reduce the use of narcotic pain medications. After a dental procedure, an injection of this type of medication around the surgical site has been shown to effectively reduce or eliminate the need for post-opera- tive opioids for pain control.
 
D9944 Occlusal guard – hard appli- ance, full arch
Removable dental appliance designed to minimize the effects of bruxism or other oc- clusal factors. Not to be reported for any type of sleep apnea, snoring or TMD appliances.
 
D9945 Occlusal guard – soft appli- ance, full arch
Removable dental appliance designed to minimize the effects of bruxism or other oc- clusal factors. Not to be reported for any type of sleep apnea, snoring or TMD appliances.
 
D9946 Occlusal guard – hard appli- ance, partial arch
Removable dental appliance designed to minimize the effects of bruxism or other occlusal factors. Provides only partial occlusal coverage such as anterior deprogrammer. Not to be reported for any type of sleep apnea, snoring or TMD appliances.
 
Rationale for D9944, D9945, and D9946: Having a code for each broad type of occlu- sal guard brings greater specificity to the code and eliminates the need for a "by report" procedure.
 
D9961 Duplicate/copy patient’s records
Rationale for D9961: Copying patient records is a frequent, non-clinical duty of the practice. Duplicates are typically provided when a patient changes providers, requests
a copy of their records for personal use, or another healthcare provider requests a copy of a common patient, etc. The patient may be charged a reasonable fee for the duplicate records.The creation of D9961 will improve the practice’s ability to track copies provided.
 
D9990 Certified translation or sign- language services – per visit
Rationale for D9990: Section 1557 of the Affordable Care Act requires covered entities to provide free language translation services to people whose primary language is not English. With this non-discrimination regula- tion in place, the CMC determined that a CDT code should exist to report translation services.
 
The federal regulation requires that lan- guage services be made available to the patient or her authorized representatives on matters involving their medical conditions and treatment. The policy also provides for communication of information contained in vital documents, including but not limited to, waivers of rights, consent to treatment forms, appointments, administrative pro- cesses, financial and insurance benefit forms, etc. Language assistance may be provided through use of certified bilingual staff, staff interpreters, contracts or formal arrange- ments with local organizations providing interpretation or translation services, or tech- nology and telephonic interpretation services.
 
Currently, translation services are among a long list of services that are reported as code D9994. Practices do not have a way to indicate that this service, specifically, was provided without a request for additional information. Establishing D9990 improves processing efficiencies and enables benefit determinations to be made without addition- al documentation. This will provide greater efficiency for both providers and third-party payers.
 
REVISED 2019 CDT CODES
 
D7283 Placement of device to facili- tate eruption of impacted tooth
Placement of an attachment on an unerupted tooth, after its exposure, to aid in its eruption. Report the surgical exposure separately using D7280.
 
Rationale for revision: Upon surgical expo- sure of an unerupted tooth, an attachment is placed (typically bonded) on the tooth to aid in its eruption. Orthodontic procedures are not performed, and orthodontic ap- pliances are not used, to achieve eruption.
 
Attachments may be placed on mesially impacted permanent first molars that are trapped by deciduous second molars. The at- tachment is designed to "unlock" the perma- nent first molars and allow normal eruption.
 
Eliminating the phrase "orthodontic bracket, band or other device" and replacing it with the word "attachment" demonstrates that this procedure may be performed for
orthodontic or non-orthodontic procedures. Payers frequently deem codes that use the term "orthodontic" in the nomenclature or descriptor as orthodontic in nature and limit reimbursement of such codes to orthodontic procedures.
 
D9219 Evaluation for moderate sedation, deep sedation or general anesthesia
Rationale for revision: D9219 is revised to add moderate sedation to the nomencla- ture. The current nomenclature implies that  a predelivery evaluation is only needed for patients who will be deeply sedated or under general anesthesia. However, that is too great a limitation, as evaluations may be needed prior to delivery of other sedation or anesthe- sia agents. This revision will enable D9219 to cover evaluations for all levels of sedation or anesthesia.

THREE DELETED CODES
D1515 Space maintainer – fixed –bilateral
Rationale for deletion: Current CDT code D1515 is not specific as to which arch is in- volved in the treatment. Therefore, numerous claims are submitted with two code D1515s
– one for each arch. This lack of specific-  ity often leads to a request for additional information so that the payer can determine
if submission of two D1515s was an error or if it was performed on both arches.
 
CDT 2019 adds D1516 (space maintainer – fixed – bilateral, maxillary) and D1517 (space maintainer – fixed – bilateral, mandibular) to specifically identify the arch treated, allowing the claim to be auto-adjudicated. Addition- ally, this specificity prevents a request for additional information and decreases reim- bursement time.
 
D1525 Space maintainer – remov- able – bilateral
Rationale for deletion: Current CDT code D1525 is not specific as to which arch is in- volved in the treatment. Therefore, numerous claims are submitted with two code D1525s
– one for each arch. This lack of specific-  ity often leads to a request for additional information so that the payer can determine
if submission of two D1525s was an error or if it was performed on both arches.
 
CDT 2019 adds D1526 (space maintainer – removable – bilateral, maxillary) and D1527 (space maintainer – removable – bilateral, mandibular) to specifically identify the arch treated, allowing the claim to be auto-adju- dicated. Additionally, this specificity prevents a request for additional information and decreases reimbursement time.
 
D9940 Occlusal guard, by report
Removable dental appliances, which are designed to minimize the effects of bruxism (grinding) and other occlusal factors.
 
Rationale for deletion: D9940 is deleted from CDT 2019 and the following three new codes are added in its place:
 
D9944 Occlusal guard – hard appliance, full arch Removable dental appliance designed to minimize the effects of bruxism or other oc- clusal factors. Not to be reported for any type of sleep apnea, snoring or TMD appliances.
 
D9945 Occlusal guard – soft appliance, full arch Removable dental appliance designed to minimize the effects of bruxism or other oc- clusal factors. Not to be reported for any type of sleep apnea, snoring or TMD appliances.
 
D9946 Occlusal guard – hard appliance, partial arch Removable dental appliance designed to minimize the effects of bruxism or other occlusal factors. Provides only partial occlusal coverage such as anterior depro- grammer. Not to be reported for any type of sleep apnea, snoring or TMD appliances.
 
This change is made because having a code for each broad type of occlusal guard brings greater specificity to the code and eliminates the need for a "by report" procedure.
 
For more information, contact Dental Benefit Director Mary Essling at (312) 337- 2169 or messling@aapd.org
 

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