Carol Tekavec, RDH
By now, many offices have become aware of the new dental-treatment codes recently released by the ADA. The Current Dental Terminology CDT-3 provides the profession with the preferred codes for reporting dental treatment to all third parties. The codes go into effect Jan. 1, 2000.
Changes include 74 new codes and 70 revised codes and descriptions. While the past revision schedule has called for new codes every five years, it is possible that more frequent updating will be occurring in the future. The ADA has stated that the CDT-3 codes will be appropriate for at least three years.
In addition to the new treatment codes, new diagnostic codes have been introduced. In the medical-coding system, treatment is reported and paid for using diagnosis codes describing the problem and treatment codes describing what procedures are needed as applied to the listed diagnosis.
Dental treatment currently is reported using treatment codes only. However, it is expected that future reporting methods will require standardized terms for defining dental issues in a completely electronic system. In plain English, this means that dental-treatment codes will be used with diagnosis codes. This system is designed to replace "by report" narratives or attachments - such as periodontal- probing depths - when filing claims by computer.
The new diagnostic-coding system, which is called the Systematized Nomenclature of Dentistry (SNODENT), will describe dental diseases and diagnoses, as well as anatomical conditions, morphology, and individual habits affecting health or treatment. It will be contained as a microglossary or subgroup within the body of the Systemized Nomenclature of Medicine (SNOMED).
Right now, an abbreviated listing is available with the CDT-3, even though no SNODENT codes currently are required by insurance carriers. After a period of time during which dentists and staff can become accustomed to the idea of diagnostic codes, the entire SNODENT will become available in a computer format.
In addition to new treatment codes, a new ADA dental-claim form has been designed for 2000 and beyond. The new form has many significant changes. The "little tooth diagram" - where missing teeth are identified on the current form - has been replaced with a simple numerical listing. The section for the carrier name and address has been expanded, and the section for reporting procedures has been altered. All calendar dates also are specified in a full month, date, and four-digit (2000) year format, as opposed to the former method of using two-digit year dates (00).
Many new code descriptions are featured in the CDT-3. For example, for the past several years it has been difficult to code crowns fabricated from some of the newer materials. None of the descriptions seemed completely appropriate. According to the new code descriptions, fiber/polymer reinforced crowns will be properly included with porcelain/ceramic crowns. Resin crowns will include all heat- and pressure- cured materials.
The code-numbering system also has changed. Instead of beginning with a "0" - such as 00120-Periodic Oral Evaluation - the new codes begin with a "D" to indicate "dental," such as D0120-Periodic Oral Evaluation.
New codes for procedures include, among many others, D0277-Vertical Bitewings-7 to 8 films; D0350-Oral/Facial Images (which includes intraoral photos); and 24 new codes regarding implants.
Using the new procedure codes will help offices be more descriptive and clear when reporting claims. Many of the new codes address procedures that previously were only correctly reported using the unspecified codes (999).
Unspecified codes, while providing dentists with a chance to fully explain an individual treatment, usually result in payment delays due to the need for a dental consultant to review the claim. The new descriptive codes are likely to help speed claim-processing.
While the existence of a new code does not mean that insurance contracts will cover the procedure, it is the first step toward getting that procedure recognized; therefore, it is important that all dental offices make every effort to use current, appropriate ADA codes.
Carol Tekavec, RDH, is the author of three insurance-coding manuals, co-designer of a dental chart, and a national lecturer with the ADA Seminar Series. Contact her at (800) 548-2164 or at www.steppingstonetosuccess.com.