Where do these codes come from?

May 1, 1998
In the year 2000, the ADA will present the dental profession with an updated and revised Current Dental Terminology CDT-3. This guide will be the ninth revision of the ADA`s "Code on Dental Procedures and Nomenclature" that was originally published in 1969. The Code undergoes a comprehensive revision every five years under the direction of the ADA Council on Dental Benefit Programs.

Carol Tekavec, RDH

In the year 2000, the ADA will present the dental profession with an updated and revised Current Dental Terminology CDT-3. This guide will be the ninth revision of the ADA`s "Code on Dental Procedures and Nomenclature" that was originally published in 1969. The Code undergoes a comprehensive revision every five years under the direction of the ADA Council on Dental Benefit Programs.

While the Code is nominally under the jurisdiction of the ADA, changes are made as a cooperative effort of the dental profession and the dental insurance industry. (The industry is represented by membership on the Advisory Committee on the Code.) The Advisory Commit-tee on the Code is made up of a representative from each of the dental-specialty groups, representatives from the Council on Dental Benefit Programs and one representative each from Blue Cross Blue Shield, the Health Care Financing Administration, the Health Insurance Association of America, the National Electronic Information Corporation and the Alliance for Managed Care Plans. The Advisory Committee reviews and votes on proposed changes to the Code. Its actions are not binding, but are important to the final outcome of revisions accepted into the new Code by the Council on Dental Benefit Programs.

Many dentists wonder what input they can have regarding changes in the Code, and how they can go about getting their opinions and recommendations heard. Requests for additions, deletions or changes may be submitted by a national dental organization, such as the Academy of General Dentistry or by a state dental society.

Individual dentists belonging to a state society may draft a recommendation and submit it through their society or through a national organization they belong to. The recommendation should include:

(1) A description of the procedure and the diagnosis that the procedure would be used for.

(2) A reason for a change to the Code.

(3) Supporting literature concerning the procedure.

(4) A statement that explains whether or not the recommendation reflects an official position of the sponsoring organization.

Other guidelines for changes include, among others, these stipulations:

(1) Revisions to the Code may be accomplished no more frequently than every five years.

(2) Changes to the Code must be in compliance with state and federal laws and regulations relating to dental treatment.

(3) Additions should not be made that represent "fragmentation, duplication or simply a means of reporting the degree of difficulty related to an existing procedure."

(4) Any changes in the Code will have no effect on whether or not the changes will be included as covered services by any benefits contract.

(5) No procedure number should be added or revised if the primary reason for the revision is for increasing or decreasing benefit levels.

(6) A procedure described in the AMA Current Procedural Terminology may be added to the Code if it can be performed by a dentist within the scope of a dental license.

The time frame for revisions is strict. No input for the CDT-3 was accepted after April 1997. This means that any dentist or organization wanting to suggest a change in the year 2000 Code would have had to make recommendations a year ago.

While the ADA Code represents the primary method dentists use to communicate with benefits plans - and despite the fact that the insurance industry has extensive input into the development of the Code - insurance carriers are under no obligation to use it. Many carriers use the Code as a base system and then add codes as desired. The existence of a code also does not mean that a procedure will be covered by any benefits plan.

The CDT-3 will be published and issued to the insurance industry during the summer of 1999. Individual dentists can purchase a copy in either late 1999 or early 2000.

Carol Tekavec, RDH, is the author of two insurance-coding manuals, co-designer of a dental chart and a national lecturer. Contact her at (800) 548-2164 or at www.steppingstonetosuccess.com.

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