Dental Coding and Billing Guidelines for Dental Practitioners

As in every medical practice billing and coding, dental coding and billing procedure has been the crucial stage of dental practice. It also includes how well codes are billed to receive proper reimbursement for every procedure performed. In simpler words, accurate dental coding and billing are often confusing and critical to performing and not everyone can do it.

Unlike medical billing, dental coding includes a range of codes with different sets and groups. As you already know that medical coding relies on ICD-10 and CPT codes regulated by the AHA and CMS. Dental coding basically uses CDT (current dental terminology) which is mainly maintained by the American Dental Association. These are the codes required for various dental treatments and claim submission/filing.

CDT Codes For Dental Coding And Billing

Dental procedure codes used for billing and coding cover oral health procedures that mainly belong to dentistry. These codes used for oral health diagnosis and procedure are alphanumeric and always begin with the โ€˜Dโ€™ and continued by 4-5 numbers. The sets of dental codes often come with descriptions specifying their necessity of applying to the type of procedures delivered. These services include;

  • Preventive
  • Diagnostic
  • Restorative
  • Endodontics
  • Periodontics
  • Implant services
  • Removable Prosthodontics
  • Orthodontics
  • Fixed Prosthodontics
  • Adjunctive general services
  • Oral and maxilla surgeries (facial)
  • Maxillofacial prosthetics

The main criteria that differ between CPT codes and CDT are that CDT code usage is limited and they are assigned by the dental hygienists and practitioners for the sections and categories of CDT codes to use.

The Necessity of Dental Codes

It is not always necessary to use CDT codes. Although, depending on the type of services acquired and the type of insurance a patient has, usually decide what codes to use and what claims to submit. Healthcare providers usually have three options for insurance coverage, they include dental, medical, and vision.

  • Many times, when healthcare providers file dental claims whether out-patient or in-network if they are connected in electronic transmission and HIPAA compliant, the dental coding procedure follows CDT codes for billing.
  • These CDT codes are national terminologies introduced by the US federal government to report claims to third-party insurance payers for dental services rendered.
  • In addition, CDT coding has been considered obligatory for electronic communication for procedures and dental services.

How Dental Practices Determine CDT Codes

ow Dental Practices Determine CDT Codes
dentalclaimsupport.com

First things first, it is mandatory to check at the first interaction at the clinic whether the patient has chosen dental insurance for dental claims. If their insurance companies do not support paying for dental procedures, it means they will not pay for the services provided. Many times, people do suppose that their medical insurance covers dental procedures, but at the time of the visit, they get to know the secret.

This is why it is essential for dental practitioners and healthcare providers to confirm if the patient has medical insurance before starting the treatment.

Insurance companies do not cover dental procedures as they fall into cosmetic surgeries which are often not covered by most of the insurance providers. To have them covered, a patient needs to be in serious health condition to convince the insurers that thereโ€™s a medical surgery need. However, it is not as simple as it may sound to portray the urgency of the procedure in detailed documentation and evidence to insurance companies so providers can claim for the same.

For example, if a patient has a cyst or ulcer in the gums and they get drained and incised in the clinic, the provided procedural services can be billed as either dental or medical. But the medical coding and the dental coding for the same condition would be different in terms of CPT and CDT codes. The CDT code D7510 will be used for abscess drainage of soft tissue whereas 41800 is used for the same procedure while CPT coding.

Several medical plans do not cover the procedures that involve treatment including teeth. The terms of the health plan coverage clearly state sometimes that any relation of procedure related to filling, treatment, care, replacement, or removal of teeth will not be covered not for dentists or patients. On the other hand, medical plans are there that cover dental implants and surgeries. For this a dental claim is filed, if it is rejected then the medical claim for the same procedure but with the amendments of CPT codes will be submitted.

How To Submit CDT Codes For Dental Billing

Suppose a medical claim is filed by using CMS 1500 form for a claim, the J400 form will be used for the process of dental claims. This J400 form is designed to fill in the information regarding dental procedures. The dental procedure information that the form requires includes;

  • Tooth system
  • Area of oral care
  • Tooth number or letter
  • Tooth surface
  • Missing teeth information
  • Procedure description

The information is required to fill the dental claim submission that indicates the treatment assigned to the patient.

CDT Codes For Dental Procedures

Diagnostic. Evaluations and Exams

DT Code(s)

  • D0120
    Periodic oral evaluation – established patient
  • D0140
    Limited oral evaluation – problem focused
  • D0150
    Comprehensive oral evaluation – new or established patient
  • D0210
    Intraoral – complete series of radiographic images
  • D0220
    Intraoral – periapical first radiographic image
  • D0230
    Intraoral – periapical each additional film
  • D0251
    Extra-oral posterior dental radiographic image
  • D0272
  • Bitewings- two radiographic images
  • D0274
    Bitewings- four radiographic images
  • D0330
  • Panoramic radiographic image
  • D0999
  • An unspecified diagnostic procedure, by the report

Example ICD-10-CM Code(s)

  • Z01.20
    Encounter for dental examination and cleaning without abnormal findings
  • Z01.21
    Encounter for dental examination and cleaning with abnormal findings
  • Z13.84
    Encounter screening for dental disorders

Preventive. Dental Prophylaxis for Adults and Children

CDT Code(s)

  • D1110
    Prophylaxis – adult D1120 Prophylaxis – child

Example ICD-10-CM Code(s)

  • E11.9
    Type 2 diabetes mellitus without complications
  • K03.6
    Deposits [accretions] on teeth
  • K05.1
    Chronic gingivitis
  • K05.10
    Chronic gingivitis; plaque-induced
  • K05.30
    Chronic periodontitis, unspecified
  • Z33.1
    Pregnant state; incidental
  • Z72.0
    Tobacco use

Preventive. Topical Fluoride Treatment

CDT Code(s)

  • D1206
    Topical application of fluoride varnish
  • D1208
    Topical application of fluoride, excluding varnish

Example ICD-10-CM Code(s)

  • K02.3
    Arrested dental caries
  • K02.61
    Dental caries on smooth surfaces limited to enamel
  • K02.7
    Dental root caries
  • K03.1
    Abrasion of teeth
  • K03.2
    Erosion of teeth
  • M35.00
    Sicca syndrome; unspecified

Other Preventive Services. Oral Hygiene Instructions

CDT Code(s)

  • D1330
    Oral hygiene instructions

Example ICD-10-CM Code(s)

  • E11.9
    Type 2 diabetes mellitus without complication
  • K02.3
    Arrested dental caries
  • K02.52
    Dental caries on pit and fissure surface penetrating into the dentin
  • K02.61
    Dental caries on smooth surfaces limited to enamel
  • K02.62
    Dental caries on smooth surface penetrating into the dentin
  • K02.7
    Dental root caries
  • K02.9
    Dental caries; unspecified
  • K03.2
    Erosion of teeth
  • K03.6
    Deposits [accretions] on teeth
  • K05.00
    Acute gingivitis, plaque-induced
  • K05.01
    Acute gingivitis, non-plaque induced
  • K05.10
    Chronic gingivitis, plaque-induced
  • K05.30
    Chronic periodontitis, unspecified
  • K05.5
    Other periodontal diseases
  • M35.00
    Sicca syndrome; unspecified
  • Z33.1
    Pregnant state; incidental
  • Z72.0
    Tobacco Use

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 a 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 the crown and predominant base alloys.
  • D6087: implants supported by the crown and noble alloys.
  • D6088: implants supported by crown and titanium alloys.

CDT Dental Codes Update

Dental Coding And Billing
outsourcestrategies.com

American dental association announce a meeting each year during the month of March to determine the new codes for dental procedures or to update the previously launched CDT codes. In the year 2020, there were 156 ADA code changes, 37 out of which were new codes that were launched, the alteration also includes 6 deleted codes, and 5 revised codes are added to the CDT 2020 dental coding.

The introduced codes in 2020 were specifically related to particular coding. All the newly introduced dental codes are specified for the use of dental needs for special conditions. CDT coding becomes challenging to use sometimes due to specificity and uniqueness. But the codes that are uniformly assigned and are accurate aid dentists and billers to maintain accurate records and proper claim submission.

They are the new codes discussed above and are directly associated with the timely repayment for dental services rendered. It also needs to keep in mind that the regular and timely audits will eliminate the risks of fraud while medical billing services ensure insurance compliance.

Conclusion

Apart from the healthcare dental industry changes that a dentist cannot control such as state regulations, Federal regulations, CDT coding changes, Patient information, and insurance policy changes. Keeping the information first-hand will make you a step ahead in submitting claims and stay apart from claim denials and rejections.

Also Read:

  1. Common Problems with Electronic Health Records
  2. Medical Billing and Coding Study: Step-By-Step Guide
  3. Consequences of Inaccurate Coding and Incorrect Billing