Coding and benefit news briefs

Sept. 1, 2004
The ADA Code Revision Committee has compiled — but not yet revealed — the new CDT-2005 codes scheduled to go into effect in January of 2005.

Carol Tekavec, RDH

The ADA Code Revision Committee has compiled — but not yet revealed — the new CDT-2005 codes scheduled to go into effect in January of 2005. My own Dental Insurance Coding Handbook — CDT-2005 will be published this fall.

According to reports, the new CDT-2005 contains 39 new procedure codes, 47 revisions, and three deletions. The dental profession, as well as all third-party payers, are required to adhere to this new version after January 1, 2005. This requirement is due to HIPAA (the Health Insurance Portability and Accountability Act) which mandates use of the ADA current version of the Code.

Sources indicate there will be a change in the description for D1110—Prophylaxis-Adult, clarifying the procedure as appropriate for controlling local irritational factors. Many other changes, including codes for recementing onlays, a new code for bone grafts placed in extraction sites for ridge preservation, and updates to the D4381—Localized Delivery of Chemotherapeutic Agents, are expected. We also are hearing about a revision/addition to the fluoride general description indicating that fluoride treatments should be prescription-strength applications, delivered under the direct supervision of a dental professional. It is believed the number of changes to the Code will be increasing in the future, with the schedule for publication of new codes remaining on a two-year basis.

In the May 17 issue of The ADA News, it was reported that the New Mexico Board of Dental Health has issued a "cease-and-desist order" to a major dental insurer to prevent the review of dental claims by any dentist or consultant who does not hold a New Mexico dental license. Many states are pursuing the restriction of dental-claim reviews to dentists who hold licenses in their respective states. Interestingly, dentists who function as dental examiners in regional exams often preside over testing in states where they do not have a license.

In the benefits arena, more third-party payers are adding the Oral CDx brush biopsy to their covered benefits. The ADA also is spotlighting the test as an important service dentists can provide for their patients. A new code for this procedure is expected to be featured in the CDT-2005 changes. Currently, dentists should use either D7286 or D7999 when filing for benefits. A copy of the patient's test results also should be sent along with the dental claim. Some insurers are reported to be covering the dentist's fee to perform the brush biopsy and collect the cell sample. The lab fee is generally paid for by the patient's medical insurance, with claims filed directly by the laboratory.

With definite guidelines, D4381-Localized Delivery of Chemotherapeutic Agents, also is being covered by a few more carriers when performed at the same time as root-planing and scaling. Those carriers providing a benefit are reportedly paying at a percentage of a basic fee. Stipulations are said to be a maximum of two teeth per quadrant, with a requirement of 5mm pocket depths and bleeding on probing. The service is paid on a per tooth basis, once per year.

Dentists who file electronic claims are generally happy with the experience, but only if the carrier also offers electronic payment. According to the National Dental EDI Council, more dentists are using electronic claims; however, the numbers are still less than 50 percent of practicing dentists. Dental carriers save money with e-filing, but many dentists find that only about one-third offer electronic- funds transfers back to the dental office. If the dental office still has to wait six weeks for payment, there is little incentive to file electronically.

I will be presenting programs at the ADA Annual Session in Orlando, scheduled for September 30 through October 3. If you are at the meeting, it would be a pleasure to see you.

Carol Tekavec, CDA, RDH, is the author of the Dental Insurance Coding Handbook Update CDT-2005, available soon. She is the designer of a dental chart and a lecturer with the ADA Seminar Series. Contact her by phone at (800) 548-2164 or visit her Web site at www.stepping

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