Practical Claims and Coding column: "Code Changes for 2009-2010"

By Carol Tekavec, CDA, RDH

The ADA coding system undergoes updating and revision every two years. It is revised under the jurisdiction of the Code Revision Committee, which is composed of equal numbers of members of the dental profession and members of the insurance industry. The ADA publishes a "Current Dental Terminology" book every two years, and has also begun publishing a separate "companion" book with additional information. Both publications are sold for approximately $60 each with a price break for ADA members. Under an ADA licensing and royalty agreement, I also publish a single coding handbook with all codes, guidance for claims, information on narratives and attachments, and other information whenever the codes are revised. For 2009-2010, there are only four new codes with 29 description wording revisions, so only an addendum is being added to my handbook.

New codes and possible dental insurance benefits

D0417 — Collection and preparation of saliva sample for laboratory diagnostic testing.

D0418 — Analysis of saliva sample, ADA definition, "Chemical or biological analysis of saliva sample for diagnostic purposes."

These two new codes may apply to various types of tests related to the determination of physiological conditions that can be diagnosed by the analysis of saliva. It is unlikely that most dental plans will provide a benefit for these procedures.

D3222 — Partial pulpotomy for apexogenesis — permanent tooth with incomplete root development, ADA definition, "Removal of a portion of the pulp and application of a medicament with the aim of maintaining the vitality of the remaining portion to encourage continued physiological development and formation of the root. This procedure is not to be construed as the first stage of root canal therapy."
Apexogenisis is said to encourage the root to continue developing as it helps to heal the pulp. The injured soft tissue is covered with a medication to encourage root growth. The apex continues to close and the walls of the root canal get thicker. If the pulp heals, no additional endodontic treatment may be necessary. This service can also ensure that a tooth is saved rather than lost. It is possible that dental plans may provide a benefit (probably in the 50% of the allowed maximum benefit range) for this code, as most allow payment toward various endodontic procedures.

D5991 — Topical medicament carrier, ADA definition, "A custom 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." This new code appears to apply only to a tray that is related to the treatment of desquamative diseases of the gingival and oral mucosa, such as pemphigus, rather than gingival or periodontal disease. It is unlikely that most dental plans will provide a benefit for this service.

There are still no codes to cover a "difficult prophy," pocket irrigation, or periodontal probing. These services are considered to be covered either by existing codes or included in the description of "larger" services. For example, periodontal probing is considered to be all-inclusive with any evaluation code.

A few revisions

There have been description revisions in the "Periodontics" D4000-D4999 section of the CDT to change the words "bounded teeth spaces" to "tooth bounded spaces." This has affected six codes in that section. The codes for topical application of fluoride for both a child D1203 and adult D1204 have been simplified, and have had the words "(Prophylaxis not included)" removed.

Code D0210 — Intraoral — complete series (including bitewings) previously did not include a description. The 2009-2010 revision contains a description: "A radiographic survey of the whole mouth, usually consisting of 14-22 periapical and posterior bitewing images intended to display the crowns and roots of all teeth, periapical areas, and alveolar bone."

Insurance carriers usually regard seven or more periapicals as a complete series. This means that regardless of the areas exposed, seven periapicals equals a complete series to insurance companies. In addition, many carriers consider a D0330 — Panoramic film to be equivalent to a D0210 — Intraoral — complete series. Some carriers regard any combination of radiographs such as four bitewings and three periapicals, taken on a given date, which meets or exceeds their allowable payment for a D0210 to be equal to a D0210 — Intraoral — complete series. If that is the case, it can mean that a true complete series may be denied future payment if taken before the time restriction (usually three to five years) ends. Insurance restrictions on payment for radiographs vary so much that it is difficult to anticipate the level of reimbursement available to a given patient. It is usually best to let patients know in advance that the radiographs that are being taken are necessary for a proper diagnosis and that their insurance may or may not cover the cost. In addition, recent ADA guidelines for the exposure of radiographs indicate that the dentist should examine the patient prior to exposing any X-rays, diagnose the need for certain radiographs, and then enter into the patient's progress notes what was discovered by those radiographs. (Guidelines can be viewed at www.ADA.org.)