Thursday Troubleshooter: There's a dental code for everything, sort of

Do you have a tough issue in your dental office that you would like addressed? Each week the experts on Team Troubleshooter will tackle those issues and provide you with answers. Send questions to [email protected].

QUESTION: I read an article in RDH magazine that mentions iontophoresis entitled, “Home and abroad, two developing products could change dental landscape.” I’m wondering if there is a CDT code for the iontophoresis? We are thinking about this delivery system with our Silver Diamine Fluoride. Any help or suggestions would be appreciated.

ANSWER FROM PATTI DIGANGI, coauthor of DentalCodeology:
There is code for everything, sort of. What I mean is, the CDT book is divided into 12 sections. At the end of every section is a D_999 code. What this stands for is unspecified, by report. For example, in the perio section, D4999 is “unspecified periodontal procedure, by report.” “By report” means that a narrative or description of the care is required.

How this is used can often influence future coding. For example, at the coding meeting in 2013, the dental benefit carriers themselves submitted for an irrigation code because it had been submitted under D4999 more than 500,000 times in 2012. They knew this because of the “by report” descriptions.

I explain this because codes are not just for insurance payments, they are also powerful metrics. With your statement, “We are thinking about this delivery system with our Silver Diamine Fluoride,” I wonder what you’re trying to measure. The code that most accurately describes Silver Diamine Fluoride is “D1354 interim caries arresting medicament application—conservative treatment of an active, non-symptomatic carious lesion by topical application of a caries arresting or inhibiting medicament and without mechanical removal of sound tooth structure.” (Yes, my CDT license allows me to take this directly from the CDT 2017 book.)

My experience is that when we have something new, we want a new code. Sometimes this is appropriate and sometimes it’s called unbundling. An example might be a crown. There are numerous parts and pieces to a crown, including anesthesia, prep, impressions, temporary crown, and more. Do each of these pieces need a code? The coding committee has voted over and over that they do not.

I know this goes a bit beyond your question, but I hope it helps you in other coding areas as well.

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