Changes to anesthesia codes in CDT 2016 prompt questions
January 28, 2016
Changes made to anesthesia and sedation procedure codes in CDT 2016 led some members to contact the ADA with questions and concerns.
Dentists are particularly interested in codes D9223 and D9243 as replacements for the previous general anesthesia and intravenous sedation codes, which resulted in changes to payment received for these services. Some dentists have stated that these changes have resulted in a lower net payment by dental benefit plans to their practice, the ADA Practice Institute's Center for Dental Benefits Coding and Quality reported.
Discussion at Annual Meeting
During its 2015 annual meeting, the Code Maintenance Committee accepted requests to delete general anesthesia codes D9220, which covers the first 30 minutes of anesthesia, and D9221, which covers each additional 15 minutes. They replaced both with one code, D9223, which documents general anesthesia delivery in 15-minute increments.
During the discussion, a majority of the committee's voting members found the submitter's rationale persuasive, that adopting a 15-minute time period increment mirrors anesthesia codes in the medical procedure code set — CPT — and brings reporting consistency between dental and medical integrated plans.
At the same meeting, the Code Maintenance Committee accepted similar requests to delete IV-sedation codes D9241 and D9242, replacing both with D9243.
The Code Maintenance Committee is the body that determines what changes — including additions, revisions and deletions — will be made to the CDT Code. Its membership represents stakeholders from the dental community, including the ADA, all ADA-recognized dental specialty organizations and third-party payers.
"By establishing this participatory and transparent process, the ADA has ensured that all communities of interest have an opportunity to voice their opinion at the meeting, so that the Code Maintenance Committee is able to reach informed final decisions," said Dr. Ron Riggins, committee chair and chair of the ADA Council on Dental Benefit Programs. "The CDT Code maintenance process relies on fully engaged participation and discussion by all of its voting member organization representatives during the meeting. It's the opportunity for all committee members to hear the full arguments, pro or con, over an action request being deliberated.
Addressing the Issues
According to Dr. Dave Preble, vice president of the ADA Practice Institute, "To address issues raised by members, the ADA has been talking to payers as they implement the new codes and claim adjudication programming. In addition, we have been answering calls and helping members on a one-on-one basis. The ADA seeks to broker a resolution with the third-party payers that will be satisfactory to all parties."
ADA staff have also been answering questions on how to report less than 15 minutes of general anesthesia, or intravenous sedation, now that the codes have changed in CDT 2016.
"There is a misperception among some ADA members and others in the dental community that the addition of "D9223 deep sedation/general anesthesia — each 15-minute increment" and concurrent deletion of D9220 for the first 30 minutes and D9221 for each additional 15 minutes means the new code cannot be used to report anything less than a full 15 minutes of anesthesia," Dr. Riggins said. "This interpretation is not correct, nor does it make any sense, especially when we look at the decades-long existence and use of D9220 and D9221."
The common perception and usage has always been that the first 30 minutes as seen in the D9220 nomenclaure means any amount of time up to 30 minutes from the procedure's start, Dr. Riggins said. "Likewise, each additional 15 minutes means any amount of additional time up to 15 minutes. This hasn't changed with the new codes in CDT 2016: each 15-minute increment means any amount of time up to 15 minutes or any subsequent increment.
"To reiterate, this is the only interpretation consistent with decades of previous usage," Dr. Riggins said.
Information about the Code Maintenance Committee
More information about the Code Maintenance Committee and the CDT Code maintenance process is available online at ADA.org/publications/cdt. The next Code Maintenance Committee meeting is scheduled for March 3-5 at ADA Headquarters in Chicago, when the group will address requests for possible inclusion in CDT 2017.
The information posted online also includes the inventories of substantive and editorial action requests on the March meeting agenda. Dentists and members of the dental community with questions can email firstname.lastname@example.org or call the ADA toll free number. Nonmembers can call 1-312-440-2500.
Code Maintenance Committee meetings are open to action request submitters and any interested party. Observers engage in the process by offering their comments on actions before the committee or by answering questions that committee member representatives pose.
ADA member dentists are encouraged to be part of the CDT Code maintenance process by preparing and submitting their own action requests. All requests received are considered by the Code Maintenance Committee.
The submission closing date for each annual CDT Code version is Nov. 1. All action requests received by Nov. 1 will be on the committee's March 2017 meeting agenda. Accepted requests will be included in CDT 2018.