Some CDT Codes, especially recent additions, may not be readily understood by dentists and others in the dental community. These codes prompt a need for a coordinated educational message on the procedure and its reporting. The American Dental Association, with support from organizations on the Code Maintenance Committee and others in the dental community, has developed a variety of educational material. This information, within the following list of topics, is available online for anyone to download, read or view.
Bitewings and Extraoral Image Procedure Codes — Video
This short video, available at no cost for you to watch, addresses the appropriate CDT code – D0251 – for documenting capture and interpretation of an extra-oral image that has the same, or more, diagnostic information than seen on multiple bitewing images.
D0411 – Guide to Point of Care Diabetes Testing (“finger-prick”) Procedure and Reporting
CDT 2018 marked the addition of “D0411 HbA1c in-office point of service testing” – a chair-side screening procedure that, along with appropriate referral, aids in the diagnosis of pre-diabetes and diabetes. This procedure, also known as finger-stick random capillary HbA1c glucose testing, is relevant to dentists as diabetes is a risk factor related to periodontal disease.
Hb1Ac testing enables a dentist to amend the patient’s treatment planning depending on whether the results are the first indicator of a new diabetic condition, or if the results indicate a change in the existing diabetic condition.
D0411 – ADA Guide to Point of Care Diabetes Testing and Reporting
is available at no cost for you to view or download.
D1354 – Guide to Interim Caries Arresting Medicament Application (aka Silver Diamine Fluoride)
CDT code D1354 has been in effect since January 1, 2016. This guide addresses two notable aspects of the procedure and its code – first that the procedure is not limited to the application of Silver Diamine Fluoride (SDF) as the medicament; and second the clarifying revision that this procedure is to be reported by tooth treated, not by number of lesions.
In some parts of the dental community D1354 has been referred to as the SDF code, which is an understandable misperception as this medicament is widely used for the procedure. The code’s nomenclature and descriptor are intentionally more broadly worded and inclusive. Find out why in the guide. Inside you will also find out about this code’s CDT 2018 revision, adding “…– per tooth” to its nomenclature so that the procedure is reported consistently.
D1354 – ADA Guide to Reporting Interim Caries Arresting Medicament Application
is available at no cost for you to view or download.
D4355 ADA Guide to Reporting Full Mouth Debridement
CDT code D4355’s nomenclature and descriptor were revised in CDT 2018 to emphasize that this is a preliminary procedure that sets the stage for a comprehensive oral evaluation on another day. But, many people ask, how is the need for the D4355 procedure determined and documented?
The publication “D4355 – ADA Guide to Reporting Full Mouth Debridement” answers this question, and more. It is available at no cost for you to view or download
D9995 and D9996 – Guide to Understanding and Documenting Teledentistry Events
CDT 2018 marks the addition of codes for documenting and reporting the two types of teledentistry scenarios a dentist can play a part in – one where data is collected and addressed in real-time, and the other where data is collected, stored and forwarded to be addressed at another time and location.
Teledentistry provides the means for a patient in one physical location to receive services, and the dentist or other oral health or general health care practitioner overseeing the delivery of those services is in another location. This mode of patient care makes use of telecommunication technologies to convey health information and facilitate the delivery of dental services without the physical constraints of a brick and mortar dental office.
D9995 and D9996 – ADA Guide to Understanding and Documenting Teledentistry Events
is available at no cost for you to view or download.
Getting Paid: Coding on a Claim Form — Video
This short video, available at no cost for you to watch, covers a number of topics that will help dentists properly prepare and submit a claim form. Services are listed below.
- Overview of dental claim form
- Recording procedure information on a service line
- Diagnostic codes on a dental claims
- ADA resources to help you submit claim
D7230 and D7240 – Guidance on Coding for Impacted Teeth Removal Procedure
The ADA’s position is that when coding for removal of impacted teeth the selection of either D7230 or D7240 is dependent on the definition of an “anatomical crown”. The full entries for these codes, as published in the CDT Manual, are:
D7230 removal of impacted tooth – partially bony
Part of crown covered by bone; requires mucoperiosteal flap elevation and bone removal.
D7240 removal of impacted tooth – completely bony
Most or all of crown covered by bone; requires mucoperiosteal flap elevation and bone removal.
An “anatomical crown” as defined by the ADA’s Glossary of Dental Clinical and Administrative Terms is as follows:
anatomical crown: That portion of tooth normally covered by, and including, enamel.
Given this definition, the “crown” referenced in these codes’ descriptors is the portion of the tooth above the cemento-enamel junction. It follows that “part of the crown” should be interpreted as “less than 50% of the entire crown” and “most or all of the crown” should be interpreted as “at least or more than 50% of the entire crown”.
An interpretation that that some portion of the occlusal surface must reside below the bone in order for D7240 to apply is an incorrect interpretation.
The dentist who removes an impacted tooth or teeth removal would consider this guidance and the full CDT Code entry when determining the code (D7230 or D7240) that appropriately describes the service she or he delivered.
D7230 and D7240 – Guidance on Coding for Impacted Teeth Removal Procedure as seen above is also available at no cost for you to download.
Guidance on Coding for Impacted Teeth Removal Procedure
Guidance on the D4346 Scaling Procedure
Patients with generally healthy periodontium receive preventive care, and those with periodontal disease involving bone and attachment loss receive therapeutic care. But what about patients who are in-between, who have widespread gingival inflammation but no bone or attachment loss? CDT Code D4346, added in CDT 2017, addresses this procedure that lies between a prophylaxis and a scaling and root planing. To learn about the procedure for these “in-between” patients and its code “D4346 scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation”, download the publication, and view the webinar delivered in September 2016
Coding for Prevention - A Primer on Procedures for Long-Term Oral Health
This program is a primer that covers a number of services and their CDT Codes that establish and support prevention and ongoing oral health. There is more – an overview of emerging interest in dental diagnosis coding, CDT Code maintenance, and where coding and claim submission assistance is available from the ADA. The material covered is pertinent to activities and services delivered by private dental practices, as well as Medicaid MCOs and Federally Qualified Health Centers (FACHs).
The program’s Part 1 begins with commentary on some things that are relatively old – several pertinent diagnostic, preventive and administrative procedures that have been part of the CDT Code for several editions. Part 2 discusses case management – ways to bring patients into your operatories so that they receive necessary dental care, and the four new CDT Codes to document these efforts. In Part 3 the program closes by addressing some ins-and-outs and how-to’s concerning codes used every day within the dental community.
Guidance on CDT Code for a "Strip Crown"
A “strip crown” is a direct procedure that involves: 1) placing a form on the tooth; 2) filling the form with composite resin that bonds directly to the tooth in the shape of a crown; 3) removal of the form from the tooth after the composite resin cures (i.e., the form is “stripped away” from the tooth and composite resin crown); and 4) finishing and final polishing as necessary.
The ADA’s position is that a “strip crown” procedure would be reported with a CDT Code listed within the “Resin-Based Composite Restorations — Direct” subcategory of service. Further, the dentist who delivers this procedure would consider the full CDT Code entry when determining the code that appropriately describes the service she or he delivered.
Should a dentist be delivering a direct composite resin restoration, selection of the appropriate CDT Code is affected by the preparation —
If the restoration is full coverage with no visible original enamel, this is a crown procedure documented with the following CDT Code.
resin-based composite crown, anterior
Full resin-based composite coverage of tooth.
(Note: Should a dentist elect to deliver such a direct crown to a posterior tooth, the applicable CDT Code is “D2999 unspecified restorative procedure, by report.”)
If some of the original enamel is preserved on any of the surfaces, this is a multi-surface restoration procedure documented with one of the following CDT Codes.
resin-based composite — four or more surfaces or involving incisal angle (anterior)
Incisal angle to be defined as one of the angles formed by the junction of the incisal and the mesial or distal surface of an anterior tooth.
resin-based composite — four or more surfaces, posterior
There is no question that a “strip crown” procedure is a direct resin-based composite restoration procedure. All the clinical steps occur inside the patient’s mouth, which meets the ADA Glossary of Dental Clinical and Administrative Terms definition of direct restorations (“A restoration fabricated inside the mouth.”). The “strip” is simply a form that enables creation of the artificial crown in-situ.
Case Management Procedures (D9991-D9994)
Case management occurs when the techniques that enable early interventions and ensure needed dental services are delivered. To learn more about these procedures and how they are being used today, and about the four CDT Codes added in CDT 2017 to document their delivery, view the program delivered in August 2016.
Documenting Interpreter and Translator Services—Affordable Care Act Section 1557
Dentists who are covered entities under Section 1557 are required to provide “meaningful access to individuals with limited English proficiency" as well as providing qualified interpreters and translators.
Read more – August 16, 2016 ADA News article concerning this regulation.
CDT Code, D9994, effective in CDT 2017, may be used to document this service through December 31, 2018. On January 1, 2019 a new CDT code – “certified translation or sign-language services – per visit” will be available to document and report this service.
Current coding guidance is available to download.
This guidance will be amended after CDT 2019 is released during the 4th quarter of 2018.
Telephone: ADA Members, please use the toll-free number on the back of your membership card; Direct dial, 312.440.2500