Tom Limoli Jr.
Third-party payers contractually reimburse only for completed procedures. They do not reimburse for individual subcomponents or techniques required to complete the procedure. With all bonded restorations, the bonding is nothing more than the technique used to complete the procedure. As such, the technique-sensitive procedures are simply coded as the completed procedure.
I do not recommend separate fees for bonded and nonbonded restorations. When taking into consideration your usual fee for the completed procedure, examine the number of bonded and nonbonded restorations that you routinely perform. Your single fee should equally address both restorative techniques. The additional cost of the bonding agent should be reflected in the total fee charged for the restoration.
According to the American Dental Association's Current Dental Terminology, "Local anesthesia is considered to be part of restorative procedures. A one-surface posterior restoration is one in which the restoration involves only one of the five-surface classifications (mesial, distal, occlusal, lingual, or facial, including buccal)."
Amalgam restorations (including polishing): "Tooth preparation, all adhesives (including amalgam bonding agents), liners and bases are included as part of the restoration. If pins are used, they should be reported separately (see D2951)."
Resin-based composite restorations — direct: "Resin-based composite refers to a broad category of materials, including, but not limited to, composites. The category] may include bonded composite, light-cured composite, etc. Tooth preparation, acid-etching, adhesives (including resin-bonding agents), liners and bases, and curing are included as part of the restoration. Glass ionomers, when used as restorations, should be reported with these codes. If pins are used, they should be reported separately (see D2951)."
Under most dental-reimbursement contracts, a sedative filling that is placed to medicate the pulp is a benefit, as long as no other treatment is rendered to the same tooth on the same date of treatment. Sedative fillings are interim treatments and are not intended to be payable with a completed restoration. If a sedative filling is reported in conjunction with a permanent restoration performed on the same date of service, it is usually classified as a component of the permanent restoration. The additional cost is not reimbursable by the benefit plan nor can it be charged to the patient.
D2940 sedative filling: "Temporary restoration intended to relieve pain. [It is] not to be used as a base or liner under a restoration."
Pulp-cap procedures are frequently and easily confused with sedative fillings. According to current terminology and reimbursement criteria, sedative fillings (D2940) are an integral part of direct pulp caps (D3110), indirect pulp caps (D3120), and even therapeutic pulpotomy (D3220) procedures. In cases where the sedative filling is identified as a completed interim restoration, pulp caps are to be identified separately from the completed restoration. Sedative fillings are not to be identified separately when the completed procedure is either a direct or indirect pulp cap.
D3110 pulp cap — direct (excluding final restoration): "Procedure in which the exposed pulp is covered with a dressing or cement that protects the pulp and promotes healing and repair."
D3120 pulp cap — indirect (excluding final restoration): "Procedure in which the nearly exposed pulp is covered with a protective dressing to protect the pulp from additional injury and to promote healing and repair via formation of secondary dentin." It is most inappropriate to deceptively seek additional reimbursement from either the patient or the patient's benefit plan by separately identifying adhesive techniques.
Tom Limoli Jr. is the president of Atlanta Dental Consultants and the editor of Dental Insurance Today, a bimonthly publication that addresses third-party reimbursement in the dental office. He also is the author of Dental Insurance and Reimbursement Coding and Claim Submission. He can be contacted by phone at (404) 252-7808. Visit his Web site at www.LIMOLI.com.