Coding Education

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.

Videos

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.

Bitewings and Extraoral Image Procedure Codes – Watch Video

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 

Getting Paid: Coding on a Claim Form – Watch Video – Watch Video

Webinars

Implant Case Procedure Coding – It’s More Than What You See In “D6000–D6199 VIII. Implant Services”
This webinar addresses a not uncommon perception – “all the codes I need are in one category of service.”  In fact, documenting and reporting an implant case from initial diagnosis and treatment planning through placement of the definitive prosthesis requires selection of CDT Codes from several different categories of service.  Codes for necessary procedures are found, for example, in the Diagnostic, Oral and Maxillofacial Surgery, and adjunctive categories of service, as well as in Implant Services.  The experienced ADA member delivering this program will discuss different real-life clinical scenarios illustrated with diagnostic images, and properly coded claim submissions.
Radiographs: What to Consider When Coding Diagnostic Imaging
Dentistry has moved well beyond the world of in-office image capture using size 2 films and panoramic imaging devices. This on-demand webinar is a multi-part program that takes a close look at the different types of images needed for diagnosis, treatment planning and operative procedures.

The recording will address the evolving tools, techniques and scenarios for image capture and interpretation, as well as provide specific answers to questions that may have come to mind such as:

  • Am I reporting bitewings correctly when capturing the image extra-orally? 
  • In a teledentistry encounter, how are image capture and interpretation procedures documented?

Featuring speakers Dr. Walter Weber (Chair, Dental Benefit Information Subcommittee at ADA Council on Dental Benefit Programs) and Dr. Jessica Stilley (Member, ADA Council on Dental Benefit Programs).

Radiographs: What to Consider When Coding Diagnostic Imaging 

Please note: CE credit is only provided for participating in the live webinar; viewing this recording does not qualify for credit.

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.

Documents (by Topic)

ADA Guide to Reporting Wound Dressings

The “ADA Guide to Reporting Placement of Wound Dressing Materials” is published to aid dentists and others in the dental community select the applicable CDT Code entry to document and report placement of materials that promote homeostasis or protect tissue during the healing process. This guide was prepared by ADA Practice Institute staff with contributions from external knowledge experts. This guide is available for you to view or download.

ADA Guide to Graft Material Collection Procedure Reporting

The “ADA Guide to Graft Material Collection Procedure Reporting” is published to aid dentists and others in the dental community on reporting services that involve soft or hard tissue grafts. It clarifies when graft material collection is reported as a separate procedure, and when material collection is part of a graft procedure. This guide was written by ADA Practice Institute staff with contributions from member dentists in practice and external knowledge experts. This guide is available for you to view or download.

COVID-19 Vaccination Procedures
During its March 2021 meeting the ADA’s Code Maintenance Committee (CMC) approved seven (7) new CDT Codes to report COVID-19 vaccination procedures (and one new code for molecular testing to identify this pathogen).  These codes are now part of CDT 2021.

There is a memorandum from the CMC Chair to the entire dental community that announces the introduction of these codes that is available for reading and download.

This memorandum also announces the new vaccination procedure coding guidance document that is also available for reading and download.

CDT 2021 (the printed manual) does not includes the newly approved COVID related CDT codes that are listed in the notification memo and guidance document described above. There is also a posting about these codes that is available for anyone to download or view on the CDT Publication Errata page.

Guide to "Image Capture Only" Procedures and Their Reporting

This guide is published to educate dentists and others in the dental community on selection and reporting of diagnostic imaging procedures documented with codes listed in the Diagnostics category of service under “Image Capture Only.”  CDT 2021 marks an expansion of codes in this sub-subcategory of service.

The “ADA Guide to ‘Image Capture Only’ Procedures and Their Reporting” is a comprehensive review and discussion of these procedures and their documentation.  This publication includes a code selection decision tree and scenarios intended to provide insight and understanding of the procedures and their reporting.

This guide was prepared by ADA's Practice Institute staff with the support of external knowledge experts, and is available at no cost for you to view or download.

Overdenture Coding Guidance - Natural Tooth and Implant Borne

This guidance document addresses confusion over appropriate documentation and reporting overdenture procedures as the applicable codes differ depending on the components and whether the prosthesis is borne by natural teeth or implants.  The two scenarios illustrate coding for placement of maxillary and mandibular overdentures for a fully edentulous patient.  This guidance also applies to placement of other types of overdentures (e.g., partial).

ADA Guide to Extractions - Tooth and Remnants

This guidance document addresses reporting extraction procedures, often referred to as “simple”, documented with CDT codes D7140, D7210 or D7250.  Selection of the applicable code depends on the clinical scenario, several of which are described herein.  Inquiries concerning these procedures led ADA staff to conclude that there is some confusion over CDT code selection.  These recurring inquires indicated that there is a need to educate dentists and others in the dental community on appropriate procedure documentation.

The “Guide to Extractions” (PDF) is available to download.

Documenting Occlusal Guards with Hard and Soft Components

Some CDT codes, especially recent additions, may not be readily understood by dentists and others in the dental community.  In response, the ADA, with support from knowledge experts in the dental community, has developed a new CDT code guide. The aim is to help dentists understand the procedures underlying these codes and how they should be reported.

The guide to reporting "Occlusal Guards with Hard and Soft Components" development was facilitated by staff in the ADA's Practice Institute."

A copy of this guidance is available to download.

Documenting Translator or Sign Language Services

Some dentists have patients who, for any number of reasons, have communication challenges that can be addressed through the use of oral translators or visual sign language. A robust patient dental record would document when such a service is provided.

The ability to record use of such services is especially valuable for dentists who are covered entities under nondiscrimination laws such as the Affordable Care Act (ACA) Section 1557. Dentists who are subject to such laws may be required to provide “meaningful access to individuals with limited English proficiency" as well as providing effective communication with individuals with communications disabilities such as vision, hearing, or speech disabilities, often through the use of qualified interpreters and translators.

As of January 1, 2019 there is a specific CDT code to document and report interpreter and translator services –

D9990 certified translation or sign-language services – per visit

CDT code D9990, first published in CDT 2019, is intended to document these services in a clinical scenario when an individual and the doctor or practice staff do not share a common language and a translator or translation service is used to ensure meaningful communication, or when a qualified interpreter is used to ensure effective communication with an individual with a disability.  Such assistance, subject to applicable regulatory or contractual requirements, is provided by qualified bilingual staff, staff interpreters, contracts or formal arrangements with organizations or individuals providing interpretation or translation services in-person or through technology and telephonic interpretation services.

NOTE:  This guidance supersedes the prior recommendation that code “D9994 dental case management – patient education to improve oral health literacy” could be used to document translation services.  CDT code D9990’s nomenclature is more explicit, therefore use of D9994 to document translation services is no longer correct.

Under nondiscrimination laws such as Affordable Care Act, Section 1557 regarding non-discrimination, there may be a requirement for covered entities to provide free language services to individuals with limited English proficiency, and effective communication with individuals with communications disabilities.  CDT code D9994 remains available for use when deemed appropriate to document services as described in the code’s descriptor.

Although D9990 refers to “certified translation or sign-language services,” ADA recommends that it apply to qualified interpretation and translation services, whether or not the provider is certified and whether the service is considered interpretation or translation.

As always, it is up to the dentist to read the full nomenclature and descriptor of a CDT code entry to determine whether the code is appropriate to report the service provided.  When the dentist determines that there is no applicable CDT code, an unspecified procedure, by report code may be used to document and report the service (e.g., D9999 unspecified adjunctive procedure, by report).

Please note that: 1) the existence of a CDT Code is not a guarantee of reimbursement for the service by a third-party payer; and 2) HIPAA only requires a third-party payer to accept a CDT Code that is valid on the date of service, and does not mandate coverage.

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 —

  1. If the restoration is full coverage with no visible original enamel, this is a crown procedure documented with the following CDT Code.

    D2390

    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.”)


  2. 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.

    D2335

    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.


    D2394

    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.

Documents (by CDT Code)

D0411 and D0412 – ADA Quick Guide to In-Office Monitoring and Documenting Patient Blood Glucose and HbA1C Level

The guide to reporting D0411 (added in CDT 2018) and D0412 (added in CDT 2019) covers these two discrete procedures for in-office monitoring of patient blood sugar levels. Development of this guide was facilitated by staff in the ADA's Practice Institute with support from other internal and external knowledge experts.

A copy of this guide is available to 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.

D1355 - ADA Guide to Reporting Caries Preventive Medicament Application
D1355 is a CDT 2021 addition. This code documents application of a caries preventive medicament a procedure that is one of several preventive services delivered to a patient based on the dentist’s diagnosis of the patient’s clinical condition. The D1355 procedure is delivered selectively when the patient’s tooth has one or more specific surfaces that are diagnosed as at high risk for development of a carious lesion.

The “ADA Guide to Reporting Caries Preventive Medicament Application” is intended to provide insight and understanding of the procedure, medicaments used, and appropriate documentation in patient records and on claims. This publication includes the rationale for adding D1355 to the CDT Code, as well as Q&A’s that describe the procedure in greater detail.

This guide was prepared by ADA's Practice Institute staff with the support of external knowledge experts, and is available at no cost for you to view or download.

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.


D4346 – The New Scaling Procedure: How It Works For You

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    D4346 – The New Scaling Procedure: How It Works For You

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      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

      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 Terms and Glossary of Dental Administrative Terms is as follows: 

      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 (PDF)

      D9912 Pre-Visit Patient Screening

      The ADA guide to reporting “D9912 Pre-Visit Patient Screening” addresses how this procedure aids determining whether there is a risk to practice staff if the patient is permitted entry, or if findings indicate that rescheduling the appointment is prudent. This guide was prepared by ADA Practice Institute staff with support from other internal and external knowledge experts. This guide is available for you to view or download.

      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.

      Case Management: Understanding the Concepts and Documenting Delivery

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        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.

        Email us anytime at dentalcode@ada.org.  You can also reach out to us from 8:00 a.m. to 5 p.m. Central time, Monday through Friday by phone 800.621.8099.