Questions and Answers
(Q&A)
These Q&A are brought to you by the Council on Dental Benefit Programs (CDBP) and add to what are in the current CDT manual. Q&A are here to assist dentist’s and practice staff determine the most appropriate procedure code to document the service provided, as well as better understand the claim form completion and adjudication processes.
Please note that; 1) this information is not part of the Code on Dental Procedures and Nomenclature (Code), and 2) dental benefit plan coverage limitations and exclusions, and where applicable the provisions of a participating provider agreement, affect third-party payer claim adjudication.
The latest Q&A follow. New information is frequently added, so please bookmark this page. Past Questions and Answers are available in the Q&A Archive | PDF file/41k  .
Coding
1. The dentist performed a frenectomy on a child that had been diagnosed with ankyloglossia. What is ankyloglossia and how would treatment be documented?
Ankyloglossia, more commonly referred to as tongue tied, is a condition in which the lingual frenum is short and attached to the tip of the tongue, making normal speech difficult.
Available procedure code:
D7960 frenulectomy ( frenectomy or frenotomy) – separate procedure
The frenum may be excised when the tongue has limited mobility: for large diastemas between the teeth; or when the frenum interferes with a prosthetic appliance; or when it is the etiology of periodontal disease.
2. A patient is having endosteal implants placed. A stent like appliance will be used as a guide while the implants are surgically placed. Would the appliance be documented as D5982 surgical stent, or D6190 radiographic/surgical implant index, by report?
Available procedure code:
D6190 radiographic/surgical implant index,
by report
An appliance, designed to relate osteotomy or fixture position to existing anatomic structures, to be utilized during radiographic exposure for treatment planning and/or during osteotomy creation for fixture installation.
A surgical stent (D5982) applies pressure to soft tissues to facilitate healing and prevent cicatrization or collapse.
3. Prior to the replacement of an ill filling maxillary complete denture, it was necessary to surgically remove an excess formation of palatal tissue. How would this procedure be documented?
Available procedure code:
D7970 excision of hyperplastic tissue – per arch
4. The patient presented with gingival lesions of vesiculobullous autoimmune diseases. A custom tray was fabricated to deliver topical corticosteroids to the mucosa. How would the tray and medication be documented?
Available procedure codes:
D5991 topical medicament carrier
A custom tray fabricated carrier that covers the teeth and alveolar mucosa, or alveolar mucosa alone, and is used to deliver topical corticosteroids and similar effective medicaments for maximum sustained contact with the alveolar ridge and/or attached gingival tissues for the control and management of immunologically mediated vesiculobullous mucosal, chronic recurrent ulcerative, and other desquamative diseases of the gingiva and oral mucosa.
D9630 other drugs and /or medicaments, by report
Includes, but is not limited to oral antibiotics, oral analgesics, and topical fluoride dispensed in the office for home use; does not include writing prescriptions.
Adjudication
Exclusions / Limitations
A patient is missing teeth 4,5,12 and 14. The dentist’s treatment plan includes a bilateral removable partial denture. The insurance company denied the partial because the teeth were extracted prior to the effective date of the insurance policy. I don’t understand why the partial was denied.
Some group health plans restrict coverage for dental conditions present before an individual’s enrollment in the plan, such as missing teeth. These restrictions are known as “pre-existing conditions” exclusions.
A pre-existing condition exclusion may also be called a “waiting period” and the length of time before coverage is available is specified in the benefit plan documents. Times can vary and the patient should contact their employer or insurance carrier for more information.
Please remember – dental benefit plan coverage limitation & exclusions, and where applicable the provisions of a participating provider agreement, affect third-party claim adjudication.
Contact Information
Telephone: ADA Members, please use the toll-free number on the back of your membership card; Direct dial, 312-440-2500
E-mail: dentalcode@ada.org |
