September 2020 Volume LV Number 5


AAPD Dental Insurance and Dental Coding Assistance

July 2020 Volume LV Number 4

 The AAPD provides members with hands-on assistance related to third-party reimbursement (dental and medical insurance) and coding. Our goal is to answer your questions regarding dental and medical coding, effective utilization of dental benefits and provide technical assistance to help resolve any difficulties that your practice may be having with claims submitted to dental or medical plans. Calls come in regularly from members seeking assistance with appealing denied claims, determining appropriate coding, utilizing general anesthesia legislation requirements, coordination of benefits, conversion of dental to medical and diag- nostic codes, the Affordable Care Act as it relates to pediatric oral health benefits, and various other third party reimbursement issues. In the PDF below is a summary of the insurance or coding matter and number of member calls received in the period from January 2019 to January 2020. All inquiries have been successfully resolved for AAPD members.

Coding and Insurance Manual
An electronic update of the AAPD Coding and Insurance Manual (2020) was offered to members free of charge due to the gen- erous support from Avesis Dental, Delta Dental of California and MCNA Dental. These corporate partners previously covered all printing and mailing costs for the 2017 Manual. The 2020 update included dental procedure codes, medical procedure codes and diagnostic codes used routinely by pediatric dentists. It also offered recommendations for submitting dental and medical claims, the appeal process for denied dental claims, contacts for all State Insurance Commissioners, carrier-friendly narratives for common procedures and a glossary of pediatric dental terms and other sources of pertinent information useful to the dental team.
Ongoing Coding and Insurance Resources
The dental benefits and coding webpage on AAPD’s website continues to be updated with new and pertinent information. Most recent updates include COVID 19 coding and infection control, benefit information on tele-dentistry, frequency limita- tions on evaluations, prophylaxis and other preventive proce- dures. In addition, timely insurance and coding information, legislation regarding non-covered services, general anesthesia and the Affordable Care Act is regularly included in AAPD E- News.
A Code Workshop was offered in February 2020 to the Mary- land Pediatric Dental Society by Mary Essling. She also contin- ues to author Behind the Code articles of interest for PDT:
July 2019
Medicaid-Medicare-CHIP Service Dental Association Annual Meeting
September 2019
ADA Credentialing Program—Spend More Time with Patients, Less on Paperwork
November 2019
Coding Advice on Primary Tooth Extractions
Know Where Auditors Look For Fraud on Dental Claim Form
March 2020
The 2019 ADA Claim Form is Now in Effect
Dental Benefits Symposium 2020
With the advent of the COVID pandemic, 2020 Annual Session plans for the Dental Benefits Symposium were cancelled. The speaker panel was to consist of: Dr. Betsy Shapiro addressing language in payor contracts and how that language can impact your patients and the success of your practice; Christine Taxin discuss diagnostic coding for dental plans and claims and its potential future uses; and Teresa Duncan to update recent coding additions, preview what’s to come for 2021 and tackle top pediatric coding FAQs. Fortunately, Ms. Taxin was be able to present during NashVirtual, and Ms. Duncan participated in an AAPD Pedo Teeth Talk podcast to discuss tele-dentistry.
Code on Dental Procedures and Nomenclature (CDT Code) Update and AAPD Initiatives
The ADA’s Code Maintenance Committee (CMC) ensures that all stakeholders have an active role in evaluating and voting on CDT Code changes. The CMC is a 21-member voting body that votes to accept, amend or decline requests.31 All requests where the decision is appealed by the submitter are returned to the CMC for further consideration.
Notable CDT 2021 additions, deletions, and revisions that pertain to pediatric dentists are as follows:
  • Editorial revisions to two CDT2020 codes, D1557 and D1558, regarding removal of a fixed bilateral space main- tainer to eliminate the descriptor "procedure performed by the dentist or practice that did not originally place the ap- pliance". The descriptor is inconsistent with the other new unilateral space maintainer removal code D1556.
  • A new code was created to record use of Silver Nitrate, Silver Diamine Fluoride, or other agents in a preventative fashion.
  • The current frenectomy code was deleted and two new codes were created to document labial/buccal frenecto- mies and lingual frenectomies (allowing more specificity).
Following the scheduled CMC meeting on March 12, 2020, the CMC convened virtually in mid-April to review and discuss new codes for COVID testing for inclusion in CDT 2021. The CMC unanimously voted to approve the following two codes, that will become official upon release in January, 2021:
D0XXX antigen testing for a public health related pathogen including coronavirus
D0XXX antibody testing for a public health related pathogen including coronavirus
The current code until CDT 2021 is implemented is D0999 un- specified diagnostic procedure, by report.
Interactions with Dental Benefits Industry
Mary Essling and the CDBP continue to interact and attend meetings on a regular basis with the American Association of Den- tal Consultants (AADC), National Association of Dental Plans (NADP), and America’s Health Insurance Plans (AHIP). Some of the scheduled spring 2020 meetings were cancelled due to COVID-19. Meetings under consideration or under commitment for AAPD participation in 2020-21 include the AHIP national conference in Washington DC, the Annual Spring Workshop of the AADC, the NADP Annual Converge Meeting, and the National Conference of Insurance Legislators Annual Meeting.
Mary Essling and CDBP Chair Dr. Jim Nickman were scheduled to meet with the payer community at the April AADC meeting in Florida. Since this meeting was cancelled, the AAPD met with payer groups virtually on April 28, 2020 to discuss member issues. Matters covered included contract provisions, overhead costs for PPE/reimbursement, and frequency leniency for periodicity schedules due to the COVID-19 pandemic.
Dental Benefits Director Mary E. Essling

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