Coding Tips and Tricks for CDT 2019

Coding guidelines state that the most specific, current CDT code should be used to document and report all dental procedures performed. It is important to update your software to reflect changes in CDT to prevent coding errors, claim rejections, and payment delays. 

In addition to adding new codes, also inactivate any deleted codes in your software. Note: Do not delete these codes from your practice management software, as it may cause some unintended issues. Also, provide your team with training on all CDT changes. These trainings must go beyond just new and deleted codes, be sure to cover any code revisions as well. 

One of the most challenging code changes this year has been the deletion of D9940 (occlusal guard). This deleted code was replaced by three new codes. 

Proper Coding 

Prior to CDT 2019, occlusal guards were reported with the same code regardless of whether the appliance was a hard or soft appliance, or whether it covered the full arch or only a partial arch. This year, D9940 was deleted and the following codes were added to document and report occlusal guards: 

D9944 occlusal guard – hard appliance, full arch 

Removable dental appliance designed to minimize the effects of bruxism or other occlusal factors. Not to be reported for any type of sleep apnea, snoring or TMD appliances. 

D9945 occlusal guard – soft appliance, full arch 

Removable dental appliance designed to minimize the effects of bruxism or other occlusal factors. Not to be reported for any type of sleep apnea, snoring or TMD appliances. 

D9946 occlusal guard – hard appliance, partial arch 

Removable dental appliance designed to minimize the effects of bruxism or other occlusal factors. Not to be reported for any type of sleep apnea, snoring or TMD appliances. 

These new occlusal guard codes distinguish between the type of material used and the amount of arch covered. The new code verbiage does not indicate which arch is involved. When reporting D9944 and D9945, indicate the arch treated in Box 25 using the appropriate two-digit number. The maxillary arch is reported as 01 and the mandibular as 02. For D9946, some payers may request the teeth numbers that the appliance covers rather than the arch treated, as in D9944 and D9945. Include this information in the narrative. 

One of the most frequently asked questions related to occlusal guard reporting is how to report a hard-soft appliance. This type of appliance is fabricated from a hard acrylic on the exterior with a soft acrylic liner. A hard-soft occlusal guard is appropriately reported as a hard appliance, D9944, as it generally covers a full arch. 

Include a narrative when reporting occlusal guards. Indicate the reason for treatment, or the diagnosis. This information should also be clearly documented in the clinical notes. The clinical record may indicate bruxism, clenching or grinding, or mobility following periodontal therapy, such as osseous surgery. Note that the descriptor for occlusal guards clearly states that the appliance is to be used to minimize the effects of bruxism or other occlusal factors and this code is inappropriate to report oral appliances for the purpose of treating sleep apnea, snoring, or TMJ disorders. 

Fees 

When there is a code change, the practice fees for the affected procedure should be analyzed. Evaluate the practice fees for each type of appliance to ensure the current fee for each of the three types of occlusal guards accurately reflects the type of material used, any lab fees associated with fabrication, and the required chairside time for adjustments. Remember, follow up adjustment visits are generally inclusive to the global fee of the appliance for six months after delivery. 

Reimbursement 

Reimbursement for occlusal guards varies greatly and is plan specific. Some plans may consider reimbursement as a periodontal guard when delivered within six months of osseous surgery, while other plans may only consider reimbursement for bruxism. The diagnosis is key to reimbursement. Remember, only report documented procedures and diagnoses. Due to variances in coverage, it is advisable to verify coverage requirements prior to submitting a claim for an occlusal guard to prevent any unpleasant reimbursement surprises.

 

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.