Carol Tekavec, RDH
The current ADA, CDT-4 code on dental procedures, which became effective in January, provides for restorative codes that do not make a distinction between primary and permanent teeth. In addition, all restorative codes are now defined as including local anesthesia. Most insurance carriers have always considered local anesthesia "all inclusive" with any other dental service. However, this version of the CDT marks the first time that the ADA has officially concurred with this view.
Codes and probable benefit interpretations for anesthesia include:
D9210-Local Anesthesia not in Conjunction with Operative or Surgical Procedures — Infrequently, dental insurance may provide a benefit when the anesthesia is being used to aid in the diagnosis of a specific problem. No benefit will apply for local anesthesia used during routine dental treatment.
D9215-Local Anesthesia — This code has never typically been a benefit of dental plans.
D9230-Analgesia, Anxiolysis, Inhalation of Nitrous Oxide — (The word anxiolysis is defined as "reduction of anxiety utilizing a pharmacologic agent such as Benzodiazipine or nitrous oxide.") This code refers to anxiety-controlling drugs. It may be a covered dental benefit when reported with oral surgery procedures. It usually is not a benefit for the use of nitrous oxide-oxygen sedation associated with routine dental procedures.
What will likely happen if a dentist continues to use D9215 and/or D9230 in addition to other treatment codes? As in the past, few, if any carriers will provide a benefit. However, many will now probably point to the change in the CDT-4 descriptions to justify the lack of payment. An additional issue is the fact that most carriers consider many components of a service to be "all inclusive." Dentists who have signed contracts to be providers for certain plans, (for example, some Delta plans), may not balance-bill a patient for the difference in the total charge for services for a code not "allowed" or separate components considered "all inclusive" by a contract. Whereas before this was only a function of an individual contract, now — in the case of anesthesia — it will also be supported by the ADA definition.
Codes and descriptions for amalgams include polishing, all adhesives, bonding agents, liners, and bases. If pins are used, they are reported separately.
Restorative codes D2110-Amalgam, One Surface, Primary; D2120-Amalgam, Two Surfaces, Primary; D2130-Amalgam, Three Surfaces, Primary; and D2131- Amalgam, Four or More Surfaces, Primary, have been deleted. To replace them, the following codes have been revised: D2140-Amalgam, One Surface, Primary or Permanent; D2150-Amalgam, Two Surfaces, Primary or Permanent; D2160-Amalgam, Three Surfaces, Primary or Permanent; and D2161-Amalgam, Four or More Surfaces, Primary or Permanent.
For Code D2150, two contiguous surfaces, such as # 3-MO or # J-MO, should be listed on a single line of the claim form. If # 3 presented with an MO and a separate DO, these should be listed on two lines of the claim form. However, insurance will likely only cover what is allowed for a three-surface amalgam restoration if the MO and DO are performed on the same day.
Posterior resin-based composites also now include primary and permanent teeth. D2391-Resin-Based Composite, One Surface Posterior, replaces both D2380 and D2385. The ADA description indicates that D2391 is to "restore a carious lesion into the dentin or a deeply eroded area into the dentin. Not a preventive procedure." (D1351-Sealant, per Tooth, is a preventive procedure-defined as either a chemically prepared or "enamel prep" surface.) Other codes are D2392-Resin-Based Composite, Two Surfaces, Posterior; D2393-Resin-Based Composite, Three Surfaces, Posterior; and D2394-Resin-Based Composite, Four or More Surfaces, Posterior.
Carol Tekavec, RDH, is the author of the Dental Insurance Coding Handbook Update CDT-4, co-designer of a dental chart and an informed consent booklet, and a national lecturer. Contact her at (800) 548-2164 or visit her Web site at www.steppingstonestosuccess.com.