Like any other medical practice, do you know that dentistry has also been affected by the complex dental coding and billing process? The complexity lies in the ability of coding procedures in order to have proper reimbursements.
To get a clear understanding of dental coding which is often intricate and critical most of the time, dental billing incurs a lot of codes, unlike many other medical billing processes.
If you are aware of the medical coding, you must know about the CPT codes (Current Procedural Terminology) that medical practices are based upon. However, dental coding relies on Current Dental Terminology (CDT). It is the type of coding designed and managed by the American Dental Association. These codes hold information about different dental procedures and are used to reimburse dental claims.
CDT codes in dental coding and billing?
These CDT codes are used in the dental industry for a set of different dental procedures. The important thing about these CDT codes is that these codes always start with the letter D (probably to show the dentistry field) and are followed by numbers and letters to form alphanumeric keys.
CDT codes are defined separately for some specific dental procedures. These specific dental codes are considered when the dental services are rendered. These services include;
- Removable Prosthodontics
- Maxillofacial prosthetics
- Implant services
- Oral and maxillofacial surgery
- Fixed prosthodontics
- Adjunctive General Services
The main difference between the medical coding CPT and dental coding CDT is that CDT limits the usage of dental codes designated by the hygienist or by dental professionals to any other category of CDT codes.
Why are CDT codes necessary in dental coding?
It is essential to understand which type of code is used while coding, CPT or CDT. To understand the correct usage of codes, it is important to determine the type of services rendered. Also, it is crucial to know the type of insurance a patient has and what claims can be actually submitted. If the patient is insured, take the complete information if the insurance provider covers the cost of dental surgery. Otherwise, they have to bear the financial costs.
Healthcare professionals typically have three types of insurance coverage;
No matter if the dental claims are submitted in or out-network or if there are electronic transmissions that are HIPAA compliant, in dental coding procedures, CDT codes will be used to bill the service. These current dental terminologies are regulated by the federal government to utilize them in billing dental services as national terminology to third-party or government-assigned insurance companies. These CDT codes are also mandatory standards of communication throughout the dental services departments and can be used for designate procedures.
How do dental practices determine CDT codes?
The patient who came for a dental procedure must have dental insurance in order to use CDT codes for dental coding and claiming reimbursements. If the health insurance does not cover dental insurance, the insurance provider will deny paying for the claims even if they possess medical insurance. Many times, patients think that their medical insurance will cover their dental expenses too, but when the claims are denied, the information hits as a surprise to them.
Dental practitioners must pay close attention to the insurance coverage that the patients hold. Certain times dental procedures are performed mainly according to the medical condition of the patients. This way patients can bill the insurance company convincing them according to the need for the dental treatment.
But it is difficult to convince insurance companies to reimburse for the services they do not cover. Even if they find out that the billed amount was made under the specific and standard CDT codes.
For instance, if a patient builds up a cyst or fungus in the gums and he has to go through a procedure in the provider’s office, the procedure can either be billed as medical or dental.
However, depending on the bills, the medical and dental coding for the same procedure is different. The CDT dental code for drainage of abscesses of intraoral soft tissue and incision is D7510 and the medical coding for the same procedure is 41800.
This means that the bills for the same procedure can be submitted under either medical or dental billing. In addition, they can also visit the dental or medical office to receive treatment. But depending on billing, either dental or medical, the claims will be submitted to the relevant insurance companies.
Usually, medical insurance companies do not cover procedures containing treatments regarding teeth. The coverage clearly states that no procedure will be catered in connection with teeth including, removal or replacement, filling, or dental care and no amount will be reimbursed to the dentist or to the patient.
Generally, medical coverages from insurance companies often cover dental implants and surgical issues. For this, a dental claim would be submitted but if denied, they can opt for a medical claim as another option.
How to process CDT codes for claim submission?
To submit the claims under dental claims against a procedure where both dental and medical coding can be used, then their forms would be different. If medical claim form 1500 is used for the procedure, the J400 form will be used for dental billing and coding.
Both the claim forms are designed to fill in the relevant and complete information. The information includes;
- Tooth system
- Area of oral activity
- Tooth number or letters
- Missing teeth information
- Procedure description
- Tooth surface
The information should be added to the dental forms along with any other information that is required. If any special treatment is performed the form may also require you to mention it.
Dental codes CDT Updates
The American Dental Association holds a meeting in the month of March every year where they determine the updated dental codes for the new year. In the year 2020, when the world was fighting the COVID-19 pandemic, including America, ADA updated about 156 codes, and 37 new dental codes were added. 6 deleted dental codes were restored and 5 of them were revised to the dental code of 2020 CDT dental coding standards.
Many 2020 CDT codes were specified to specific procedures. According to the new dental codes, they should be used while special services are rendered to patients with dental care needs and procedures. Coding either medical or dental has remained critical when it comes to billing and filing claims. On the other hand, uniform and accurate medical coding help physicians and dentists to claim accurate submission and maintain records properly.
If dental claims are timely submitted, they help in continuous reimbursements against dental claims without any delays. Also, awareness of the regular updates and assurance of compliance will reduce the chances of claim denials.
New Codes for dental coding
- D0419: Assessment of salivary flow by measurements.
- D5284: Removable unilateral partial denture and one-piece flexible base including claps and teeth per quadrant.
- D2753: code for the crown, titanium as well as titanium alloys.
- D5286: Removable unilateral partial denture and one-piece resin including claps and teeth per quadrant.
- D6082: code for implants supported by crown, porcelain fused to predominantly base alloys.
- D6083: code for implants supported by crown, porcelain fused to noble alloys.
- D6084: code for implants supported by crown, porcelain fused to titanium or titanium alloys.
- D6086: implants supported by a crown and predominant base alloys.
- D6087: implants supported by a crown and noble alloys.
- D6088: implants supported by crown and titanium alloys.
CDT 2020 updates
The American Dental Association has introduced new codes for the dental practice that should be used for billing from January 1, 2022. The changes include 16 new, 14 revised, and 6 deleted codes. In the CDT 2022 update, a specific section of ICD-10 codes is assigned. These codes will cater to the services and cover the following procedures;
- Rebasing of hybrid prostheses
- Pre-visit patient screening
- Removing temporary anchorage devices
- Partial dentures did immediately
- Intra and extra coronal splints
- Repairing and adjusting sleep apnea appliances
There are 8 particular codes for vaccine administration and testing of pathogens that are a menace to public health. Considering the current pandemic situation, the American Dental Association included these eight codes in the 2022 update.
The 7 codes that are purely associated with the vaccine administration process include;
- D1701 and D1702 refer to Pfizer-BioNTech COVID-19 vaccine administration first dose and second dose respectively.
- D1703 and D1704 refer to the Moderna COVID-19 vaccine administration first dose and second dose respectively.
- D1705 and D1706 refer to AstraZeneca COVID-19 vaccine administration first dose and second dose respectively.
- D1707 refers to Johnson & Johnson COVID-19 vaccine administration.
The codes D8040, D8020, D8010, and D8030 were revised with the updated language of Limited Orthodontic treatment.
The new updated definition shows that any orthodontic treatment will be considered Limited Orthodontic treatment which goes through the therapeutic modality with specific treatment in any level of dentition.
With the above dental and billing and coding information, you must have understood the importance of dental coding and billing. It is important to look for updates each year to successfully reimburse claims and reduce the denial rates.