By Carol Tekavec, RDH
In the past, the ADA Council on Dental Benefit Programs updated treatment codes on a five-year basis. Now it appears that updates will be appearing more frequently. Insurance carriers have been accustomed to creating their own coding systems based on the ADA code; however, the Health Insurance Portability and Accountability Act of 1996 makes the current version of the ADA code the "official code set." All providers and insurers must use the current version of the code. For now, that is the 2003 version. In addition, current codes and detailed records are essential for documentation of treatment for possible utilization-review issues. Your documentation via recordkeeping can support your use of the codes.
What has changed in the ADA 2003 codes? A lot! There are 52 new codes, 40 revised codes, and 27 deleted codes. The wording for many section headings has also changed. (For information about my updated coding manual, featuring all of the coding changes, call (800) 548-2164).
A few of the changes: include
• D0180-Comprehensive Periodontal Evaluation-New or Established Patient: This new code describes a detailed periodontal evaluation on a patient with more than typical periodontal-disease risk factors. As before, periodontal probing is considered to be a part of any evaluation and does not have a separate code.
• D1110-Prophylaxis, Adult: This code has a revised definition indicating that it is for "coronal scaling and/or polishing to remove coronal plaque, calculus, and stains." Why the definition for a standard prophy continues to be downgraded is not known. A coronal polishing procedure can be performed by dental assistants in many states and is typically not considered to be an adequate service for most adults.
• Topical Fluoride Procedure: The new ADA definition indicates that fluoride must be applied separately from prophy paste and "does not include fluoride rinses or 'swish."
• Local Anesthesia: All code sections have been altered to indicate that local anesthesia is considered to be a part of general treatment procedures.
• Revised wording, D4341-Periodontal Scaling and Root-Planing, Four or More Contiguous Teeth or Bounded Teeth Spaces per Quadrant: Previously, the ADA did not specify the number of teeth per quadrant. Most carriers require five teeth with loss of attachment or bone (5mm or deeper) to qualify for a benefit.
• New code, D4342-Periodontal Scaling and Root-Planing, One-to-Three Teeth, per Quadrant: This code will be helpful for reporting a single tooth root-planing.
• Revised wording, D4910-Periodontal Maintenance: The new definition does not include any evaluations or examinations. (The 2000 ADA code indicated that a "periodontal evaluation" was included.) Carriers are expected to continue to provide a benefit for the D490 code, but not for an exam coded separately and performed at the same time.
• The differentiation between primary and permanent teeth for amalgam restorations has been eliminated. (Codes D2110, D2120, D2130, and D2131 are gone. D2140, D2150, D2160, and D2161 have been revised to include primary or permanent teeth.)
• Posterior Resin-Based Composites now include primary and permanent teeth. The new codes are D2391, D2392, D2393, and D2394.
• Revised description for D2950-Core Build-up now states that this procedure should not be reported when it "involves a filler to eliminate any undercut U"
• D7287-Cytology Sample Collection: A new code for a "brush biopsy."
• New codes for extractions: They are D7111-Coronal Remnants-Deciduous Tooth and D7140-Extraction, Erupted Tooth, or Exposed Root. Previous codes D7110-Single Tooth, D7120-Each Additional Tooth, and D7130-Tooth Removal, have been deleted.
Carol Tekavec, RDH, is the author of the Dental Insurance Coding Handbook Update CDT-4, co-designer of a dental chart and an informed consent booklet, and a national lecturer. Contact her at (800) 548-2164 or visit her Web site at www.steppingstonestosuccess.com.