Carol Tekavec, RDH
The new ADA CDT-2005 codes go into effect this month. As per HIPAA regulations, all dentists and payers must use the 2005 version of the dental codes beginning January 1. Many offices may have already received notices from third parties that a code(s) they have submitted is not "current." (Visit my Web site at www.steppingstonestosuccess.com for information about my new coding handbook containing all CDT-2005 codes and insurance guidance.) Dentists must use correct coding to help patients receive the benefits which they or their employers are paying for. Delays occur when codes are wrong.
As I mentioned in my November 2004 column, revisions to Code D1110-Adult Prophylaxis - as well as the description for topical fluoride - are changes offices need to be alert to since these services are performed frequently. Many other important revisions have been made adding up to 39 new codes, 47 revisions, and three deletions in all.
Notable new codes
D2794-Titanium Crown. This new code is believed to refer to any titanium or titanium and porcelain (or any other surface material) crown. Insurance benefits will likely be based on existing contract parameters at a 50 percent, major procedure level.
D2934-Prefabricated Esthetic-Coated, Stainless-Steel Crown-Primary Tooth. Previously, stainless-steel crowns had to be crimped and contoured before being sent to a lab to have a white coating put on the facial surface for esthetic purposes. Prefabricated esthetic-coated, stainless-steel crowns eliminate a lab fee. This new code probably will be a benefit for anterior teeth in children under age 12.
D7953-Bone Replacement Graft for Ridge Preservation-Per Site. This new code applies to bone grafts placed in extraction sites. Many carriers will cover anterior bone grafts. Most will not pay a benefit for grafts used on "routine" posterior extractions. If an extraction is done in conjunction with a proposed implant - and implant services are a benefit of the patient's contract - some benefit may apply. (This is true within the restrictions of typical annual limits of $1,000 to $1,500.)
Also, many of the periodontal procedure codes have been "adjusted" so their descriptions match. Periodontal codes that previously mentioned "four or more contiguous teeth or bounded teeth spaces per quadrant" now include all codes that apply to this definition. (A "bounded teeth space" situation might be where Tooth No. 2, Tooth No. 3 and Tooth No. 5 are present. Tooth No. 4 is missing. The edentulous area between Tooth No. 3 and Tooth No. 5 is a "bounded tooth space.")
D2910-Recement Inlay, Onlay, or Partial Coverage Restoration. This code has been revised to include onlays and partial coverage restorations, such as facial veneers. Some benefit may be paid if the restoration has been in place for six months to one year.
D2970-Temporary Crown. Possible substitutions might be D2931-Prefabricated Stainless Steel Crown or D2932-Prefabricated Resin Crown, neither of which would be appropriate for the interim crown placed temporarily while the permanent crown is being fabricated.
D6020-Abutment Placement. See revised code descriptions for D6056-Prefabricated Abutment and D6057-Custom Abutment for substitutions.
D7281-Surgical Exposure of Impacted or Unerupted Tooth to Aid Eruption. See the revised code descriptions for D7280-Surgical Access of Unerupted Tooth and new Code D7283-Placement of Device to Facilitate Eruption of Impacted Tooth for appropriate substitutions.
Many offices wonder which code set they should use for a patient's claim when the services are performed toward the end of a calendar year. Should it be the code set in effect when the treatment is performed or the code set in effect on the date an office transmits the claim? The answer is that offices are expected to use the code set in effect at the time the treatment is performed. This means if treatment is completed on Dec. 30, 2004, but the claim is not submitted until Jan. 3, 2005, the office should use the CDT-4 version code set in effect from Jan. 1, 2003, through Dec. 31, 2004.
Carol Tekavec, CDA, RDH, is the author of the Dental Insurance Coding Handbook Update CDT-2005. She is the designer of a dental chart and is a lecturer with the ADA Seminar Series. Contact her by phone at (800) 548-2164 or visit her Web site at www.steppingstonestosuccess.com.