CDT 2018 New Code Update

The Code on Dental Procedures and Nomenclature (CDT) provides a standard language for dental teams to accurately track and document the procedures they perform and to properly submit those procedures to payers.

When reporting CDT, remember that the existence of a CDT code does not imply that the procedure will be reimbursed. While payers are required to recognize CDT codes, they are not obligated to pay for a procedure simply because a code exists.

CDT is maintained by the ADA’s Code Maintenance Committee (CMC). The CMC meets each year to review code change requests and determine which submissions will become part of CDT. The final tally for changes to CDT 2018 includes 18 new codes. These code changes became effective January 1, 2018.

18 New Codes

D0411 HbA1c in-office point of service testing
D0411 is added to CDT 2018 to report an in-office HbA1c test. This code reports a qualified dental professional’s collection and testing of a HbA1c sample, as well as the preparation of any reports related to the testing. It does not describe the simple testing of a patient’s resting blood sugar levels with a glucometer.

Repair Codes

  • D5511 Repair broken complete denture base, mandibular
  • D5512 Repair broken complete denture base, maxillary
  • D5611 Repair resin partial denture base, mandibular
  • D5612 Repair resin partial denture base, maxillary
  • D5621 Repair cast partial framework, mandibular
  • D5622 Repair cast partial framework, maxillary

 

Denture codes are typically reported based on the arch treated and indicate whether the prosthesis is a complete or partial denture. However, the three prior complete and partial repair denture codes that do not follow this standard and the specific arch must be specified on the claim.  Note CDT 2018 deletes the existing repair codes (D5510, D5610, and D5620).

D6096 Remove broken implant retaining screw
D6096 is added to CDT 2018 to report the removal of a broken implant retaining screw. This removal relates to a screw that is broken and cannot be easily accessed. D6096 does not report the routine removal or tightening of an intact implant screw.

For example, a patient presents with a one-piece implant retained crown in hand. The doctor evaluates the patient’s condition and determines that the screw retaining the implant-supported crown is broken. The doctor removes the piece of the screw remaining in the body of the implant as well as the portion that remains in the loose implant retained crown. The removal of the broken implant retaining screw is reported as D6096.

D6118 Implant/abutment supported interim fixed denture for edentulous arch – mandibular
Used when a period of healing is necessary prior to fabrication and placement of a permanent prosthetic

D6119 Implant/abutment supported interim fixed denture for edentulous arch – maxillary
Used when a period of healing is necessary prior to fabrication and placement of a permanent prosthetic

Following implant placement, a healing period is required to allow the implant to integrate and the surrounding tissue to heal before the definitive final prosthesis is placed. During this healing period, interim fixed dentures may be placed in an edentulous dentition to prevent the patient from going without teeth. This interim fixed prosthesis is intended to be used for a limited period while the tissues are healing and are not intended to be a permanent prosthesis.

Report abutments that support the interim fixed denture separately using the correlating abutment code (i.e., D6051, interim abutment, D6056, prefabricated abutment, or D6057, custom fabricated abutment).

Reimbursement for interim implant/ abutment supported fixed dentures is very limited. If implant services are covered, most payers will only provide reimbursement for one prosthesis, either the interim or final prosthesis. Additionally, the period qualifying as an interim period varies by the payer; some payers allow up to a six-month period, others up to one year.

D7296 Corticotomy – one to three teeth or tooth spaces, per quadrant
This procedure involves creating multiple cuts, perforations, or removal of cortical, alveolar or basal bone of the jaw for the purpose of facilitating orthodontic repositioning of the dentition. This procedure includes flap entry and closure. Graft material and membrane, if used, should be reported separately.

D7297 Corticotomy – four or more teeth or tooth spaces, per quadrant
This procedure involves creating multiple cuts, perforations, or removal of cortical, alveolar or basal bone of the jaw for the purpose of facilitating orthodontic repositioning of the dentition. This procedure includes flap entry and closure. Graft material and membrane, if used, should be reported separately.

With advances in technology and an increasing number of adults seeking orthodontic treatment comes increasing requests for shorter orthodontic treatment times. Accelerated orthodontic treatment comes in many forms. One method of decreasing orthodontic treatment time is the corticotomy procedure.

A corticotomy involves making cuts or perforations or removing cortical, alveolar, or basal bone around the teeth that require movement. This technique encourages tissue regeneration to reposition the teeth more quickly than traditional orthodontic treatment. A corticotomy can accelerate tooth movement, decrease treatment time, and enhance post-treatment stability.

Reimbursement for corticotomy procedures will apply to the patient’s orthodontic lifetime maximum, since it is a surgical procedure related to orthodontic treatment.

D7979 Non-surgical sialolithotomy
A sialolith is removed from the gland or ductal portion of the gland without surgical incision into the gland or the duct of the gland; for example via manual manipulation, ductal dilation, or any other non-surgical method.

A sialolithotomy may be performed either surgically or non-surgically, and the procedure differs between surgical and non- surgical. Accordingly, the CMC decided that the procedure should be reported based on whether or not the procedure was surgical in nature.

D7979 is created to report a nonsurgical sialolithotomy. With this addition, D7980 is revised to add the word “surgical” to the nomenclature, distinguishing the two codes.

The following is an example of a non-surgical sialolithotomy: A patient is complaining of periodic swelling in the sublingual area. The dentist evaluates the patient’s condition and determines there is a sialolith that periodically blocks the sublingual duct. The doctor “milks” the sialolith out of the duct, without surgical intervention, to prevent future occlusions of the duct by the offending sialolith.

D8695 Removal of fixed orthodontic appliances for reasons other than completion of treatment
Occasionally, orthodontic appliances are removed for unexpected circumstances and then reapplied in the middle of treatment. Circumstances, when braces are removed other than at the end of treatment, include weddings, proms, MRIs, financial issues, etc. D8695 now reports the removal of fixed orthodontic appliances.

D9222 Deep sedation/general anesthesia – first 15 minutes
Anesthesia time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and noninvasive monitoring protocol and remains in continuous attendance of the patient. Anesthesia services are considered completed when the patient may be safely left under the observation of trained personnel and the doctor may safely leave the room to attend to other patients or duties.

The level of anesthesia is determined by the anesthesia provider’s documentation of the anesthetic effects upon the central nervous system and not dependent upon the route of administration.

D9222 is now added to report deep sedation/ general anesthesia – first 15 minutes. D9223 is revised to report deep sedation/general anesthesia – each subsequent 15-minute increment.

D9239 Intravenous moderate (conscious) sedation/analgesia – first 15 minutes
Anesthesia time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive monitoring protocol and remains in continuous attendance of the patient. Anesthesia services are considered completed when the patient may be safely left under the observation of trained personnel and the doctor may safely leave the room to attend to other patients or duties.

D9239 is created to report intravenous moderate (conscious) sedation/analgesia – first 15 minutes. D9243 is revised to report intravenous moderate (conscious) sedation/analgesia – each subsequent 15-minute increment.

D9995 Teledentistry – synchronous; real-time encounter
Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.

D9996 Teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review
Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.

Conclusion
This article has provided an overview of the new CDT codes added in 2018; however, it is important to maintain current coding resources and educate your team. Current resources and an educated team are key elements to maintain coding and insurance administration compliance.  Order Dr. Blair’s Coding with Confidence Guide to stay current with CDT codes.

Dr. Charles Blair is dentistry’s leading authority on insurance coding strategies, fee positioning and strategic planning. He has individually consulted with thousands of practices, helping them identify and implement new strategies for increasing legitimate reimbursement. He currently offers several publications: Coding with Confidence, Administration with Confidence, Medical Dental Cross Coding with Confidence and the Insurance Solutions Newsletter. He also founded www.practicebooster.com, which optimizes insurance administration and aids in maximizing reimbursement. He holds degrees in Accounting, Business Administration, Mathematics and Dental Surgery.