By Patti DiGangi, RDH, BS
Many of us have thought, "I wish there was a more accurate CDT code for my treatment." Dental procedure coding can seem frustrating and intimidating, yet change is possible. Each of us can and need to have a voice in coding with the advent of interoperable electronic health records (EHR) and oral-systemic health care. The collaborative work of dentists and Perio Protect, LLC, to have a new procedure code added may provide an instructive guide.
Minnesota policymakers recently upped the ante for better coding options when they voted on July 25, 2013, to require dentists, oral surgeons, and orthodontists to adopt a certified, interoperable EHR system, similar to their medical counterparts, by 2015. Dental codes are the responsibility of the American Dental Association Code Maintenance Committee (CMC) formed in 2012. Currently, the Code on Dental Procedures and Nomenclature (CDT Code) outlines procedure codes. General agreement on diagnostic coding, required for EHR, is still needed.
To facilitate changes in the electronic transmission environment, this CMC will update CDT every year. Although procedure codes are used for processing third-party payment, the primary purpose of the CDT codes is to achieve uniformity, consistency, and specificity in accurately reporting dental treatment. Creating codes to embrace new technologies, materials, and procedures not only can help achieve these goals, but also may help lead to earlier arrest and prevention of oral diseases. The existence of any code does not mean a patient has coverage under a policy. Yet, without a code, no coverage could be offered.
A CDT change request can be submitted at any time; yet there are deadlines for the committee's annual reviews. The CMC guidelines are clearly spelled out and readily accessible (www.ADA.org). The CMC holds a strict timeline. By May 1, 2014, preparation of CDT 2015 will be complete. A previously declined request can be resubmitted and must include new information that wasn't available at the time of the original request.
A recent example is gaining an accurate code for the minimally invasive procedure using Perio Protect trays. The Perio Tray is a prescription medical device that places medication in the sulcus or periodontal pocket. It is not co-packaged with any medication. It is simply an effective tool for subgingival delivery. Medication delivered with Perio Trays address biofilm infections, inflammation, root caries, or recession-induced sensitivity. The trays have customized seals and extensions fabricated along the interior periphery to prevent medication from leaking and provide positive pressure to direct medication deep into the sulcus and periodontal pocket. Perio Trays are classified as prescription medical devices, they require a doctor's script, and must be fabricated in a dental laboratory registered with the FDA and trained by Perio Protect LLC.
Through CDT 2013, the only code available for the procedure was D5991 topical medicament carrier, which did not accurately describe the procedure. Code requests were submitted and declined in previous years. Each resubmission required new information. The Perio Trays submission process for CDT 2014 included extensive new research.
Public testimony from Dr. Alan Friedel, past chair of the Code Revision Committee (committee with code responsibility from 2001-2011), gave valuable input. The Academy of General Dentistry and more than 500 private dentists prescribing Perio Trays also supported a new code. The many years of effort and research showed the benefits of this procedure. CDT 2014 includes the new code D5994 periodontal medicament carrier with peripheral seal – laboratory processed.
Deciding which of their plans and policies will provide coverage for this new code is the next step for insurance carriers. Offices that prescribe Perio Tray can and need to have a voice in the decision-making process. Insurance carriers understand risk assessment; their entire business model is based on risk. They understand the value of minimally invasive procedures and research evidence.
With continuing expansion of oral-systemic evidence, keeping a narrow focus only on dental codes might be a disservice to our patients. Oral care is currently medically billable yet must show proof of medical necessity. The common medications prescribed to treat many of these medically billable conditions to address biofilm infections, inflammation, root caries or recession-induced sensitivity delivered with Perio Trays will often qualify under medical necessity.
Staying current on coding is a continuous process. Being proactive means thinking and acting ahead of anticipated events; this means foresight. Creating proactive strategies can make a difference.
Patti DiGangi, RDH, BS, is a certified health information technology trainer and holds a publishing license with the American Dental Association for Current Dental Terminology. DentalCodeology: More Than Pocket Change is her first book of a series designed to guide dental clinicians into the coding and electronic health records world. You may contact her by email at [email protected].
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