There’s an old saying, “What you don’t know won’t hurt you.” But in the case of changes to CDT codes D0210 and D4355, what you don’t know will hurt your bottom line.
Were you aware that CDT codes can change more than once in a calendar year? Did you know that there have been 160 CDT coding changes in the last three years? New codes can be added, existing codes can be revised, and outdated codes can be deleted.
Using a deleted code on a claim will lead to denial of the claim. Using a revised code in a way it is no longer intended will also trigger a denial. And not knowing about a new code can cause lost benefits for the patient.
More about 2023 coding changes: New year, new ADA CDT codes
Benefit providers will not correct your claim coding mistakes and will seldom tell you on the explanation of benefits (EOB) why the claim was denied. You must call them to get an answer. Insurance coordinators report spending two to three hours daily on the phone with plan administrators to learn why claims are denied. Most of this time and money wasted can be prevented.
Keeping up with coding changes is easy and affordable compared to losing thousands in incorrect claim filings, time on the phone, challenging denied claims, and appealing denials. Here are two changes and how they affect your revenue.
D0210 intraoral-comprehensive series of radiographic images
This is a radiographic survey of the whole mouth intended to display the crowns and roots of all teeth, periapical areas, interproximal areas, and alveolar bone, including the edentulous area.
Before the change in 2023, you had to take 14 to 22 periapical and posterior bitewing images to display the crowns and roots of all teeth, periapical areas, and alveolar bone to qualify as a comprehensive series. Now you may take as few radiographs as necessary as long as the series displays the crowns and roots of all teeth, periapical areas, interproximal areas, and alveolar bone, including the edentulous area. You still have to record your medical necessity for the radiographs clinically.
D4355 full-mouth debridement
This enables a comprehensive periodontal evaluation and diagnosis on a subsequent visit. The debridement code has been controversial for some time because of the issue of evaluations at the same appointment. The change this year is a welcome one.
Many patients were forced to postpone preventive visits during the shutdown. Now patients are returning with neglected mouths and much-needed dental care. Patients in rural areas, nursing homes, and those who are disabled have limited resources to get to the dentist. Before 2023, the full-mouth debridement code was indicated to enable the dentist to evaluate the patient on a subsequent visit. Now you may perform a D0120, a D0140, or a D0150 on the same visit as a D4355. D0150 can be performed on patients of record who have not been in your practice for three years.
How many of your patients are coming back and need a full-mouth debridement but get a prophy instead? Ask any hygienist and they’ll agree that a patient who hasn’t had a recare visit in one to three years is a challenge for an hour-long prophy. A hygienist will probably say it was not a prophy.
If a patient shows signs of periodontal disease, has diabetes, or is a smoker, get them back for a D0180 comprehensive periodontal evaluation-new or established patient. The appointment will include six-point periodontal charting, evaluation for periodontal conditions, and an evaluation for oral cancer, along with a dental and medical history evaluation, the recording of caries, missing or unerupted teeth, existing restorations, and occlusion.
The ADA is always changing the CDT codes. New technology, new treatment deliveries, and keeping in accordance with the HIPAA act of 1996 and other federal regulations are some of the main reasons for the yearly changes.
For the sake of your patients, your dental team, and your business viability, update your CDT code books every year. This is a small price to pay for peace of mind and to maximize legitimate reimbursement.
This article originally appeared in DE Weekend, the newsletter that will elevate your Sunday mornings with practical and innovative practice management and clinical content from experts across the field. Subscribe here.