Deletions For CDT 2007-2008

D1201-Topical Application of Fluoride (Including Prophylaxis)-Child has been deleted. Use instead D1203-Topical Application of Fluoride (Prophylaxis not Included)-Child in addition to D1120-Prophylaxis-Child to report a child prophy and fluoride treatment. (There is also a new code for fluoride varnish, D1206-Topical Fluoride Varnish, which is described as being appropriate for moderate to high caries risk patients.)

D1205-Topical Application of Fluoride (Including Prophylaxis)-Adult has been deleted. Use instead D1204-Topical Application of Fluoride (Prophylaxis not Included)-Adult in addition to D1110-Prophylaxis-Adult to report an adult prophy and fluoride treatment (or D1206-Topical Fluoride Varnish plus D1110-Prophylaxis-Adult).

D6971-Cast Post as Part of Fixed Partial Denture Retainer has been deleted. It describes a procedure that is apparently no longer a common component of current dental school curricula. According to the ADA Evaluation Criteria concerning changes to the Code, this situation can qualify a code for removal. A possible substitute might be newly revised D6970-Post and Core in Addition to Fixed Partial Denture Retainer-Indirectly Fabricated, or others depending on the situation.

New Codes for CDT 2007-2008

There are 23 new codes for 2007-2008; among them are the following:

D0145-Oral Evaluation for a Patient under Three Years of Age and Counseling with Primary Caregiver. This code is described by the ADA as being appropriate for “diagnostic and preventive services performed for a child under the age of three…” It is likely that this code will be paid by carriers at the same rate as any other “evaluation” or “examination.” That is, the first D0145 appointment will likely be paid at a “comprehensive” examination rate, once every 3 to 5 years, with subsequent D0145 visits paid at the rate covered for D0120-Periodic Oral Evaluation.

D2970-Temporary Crown (Fractured Tooth). This code was removed from the CDT 2005-2006, but reinstated for the CDT 2007-2008. It is believed to be appropriate for pre-made crowns placed as short-term restorations for teeth that have been damaged, have pulpal involvement, or have a questionable prognosis. This code is not appropriate to describe a temporary crown used during crown/bridge fabrication. The addition of a narrative on the claim form may facilitate third-party benefits for this code, even though it is not a “by report” code. The narrative should be placed in area #35-Remarks- on the ADA claim form. It is important that whenever a narrative is used it be brief, treatment specific, and patient specific, not checked off from a listing.

D0360-Cone Beam CT-Craniofacial Data Capture, D0362-Cone Beam-Two Dimensional Image Reconstruction Using Existing Data, Includes Multiple Images, and D0363-Cone Beam-Three-Dimensional Image Reconstruction Using Existing Data, Includes Multiple Images. According to medical sources, cone beam computed tomography is based on computed tomography or CT scan, wherein a scanner directs a series of x-ray pulses through the body. Each x-ray pulse represents a “slice” of the area being scanned. The difference is that with a cone beam CT scanner, there are no image “slices.” Instead, a beam illuminates a complete image at once, with specific sections observed from many different angles. An entire image may be reconstructed in 3 dimensions. Cone beam CT scanning may be used in dentistry instead of panographic or MRI technology; for example when identifying anatomy prior to implant placement. It is unlikely that most dental carriers will cover these codes. An exception might be when a plan covers implants, but then it would be only up to the annual maximum plan allowance. Medical plans may cover these services, depending on the plan. These “scanner” codes illustrate a growing new awareness of the intricate connections between oral health and systemic health. It is believed that closer cooperation between medical and dental carriers may result in better treatment options available to patients, possibly in the very near future.

D4230-Anatomical Crown Exposure-Four or More Contiguous Teeth and D4231-Anatomical Crown Exposure- One to Three Teeth per Quadrant. The ADA description for these codes indicates that “this procedure is utilized in an otherwise periodontally healthy area to remove enlarged gingival tissue and supporting bone (ostectomy) to provide an anatomically correct gingival relationship.” It is likely that third parties will require documentation that these procedures are being performed for noncosmetic purposes in order for a benefit to apply. Although these code descriptions do not specify “by report,” an explanation of the reasons the services are necessary may help to gain a benefit for patients.

Revised Codes For CDT 2007-2008

There are 33 revised codes for 2007-2008; among them are the following:

D0120-Periodic Oral Evaluation-Established Patient. The ADA description, “An evaluation performed on a patient of record to determine any changes in the patient’s dental and medical health status since a previous comprehensive or periodic evaluation. This includes an oral cancer evaluation and periodontal screening where indicated, and may require interpretation of information acquired through additional diagnostic procedures. Report additional diagnostic procedures separately.” The ADA has added the words, “established patient” to the code title, indicating that they believe that D0120 is for a previous patient of the office. An “oral cancer evaluation where indicated” is also now listed as a recognized procedure under a periodic evaluation. A periodontal screening “where indicated” shows that the ADA believes that periodontal screening is performed at the dentist’s discretion.

D0150-Comprehensive Oral Evaluation-New or Established Patient and D0180-Comprehenisve Periodontal Evaluation-New or Established Patient have had their descriptions revised to include “oral cancer evaluation” as opposed to “oral cancer screening.” D0150 also now includes evaluation of “existing prostheses” and “periodontal screening and/or charting.” There is still no separate code for periodontal charting. The ADA considers it to be a part of the examination or evaluation process.

D0180 –Comprehensive Periodontal Evaluation to be interchangeable in terms of benefits, ie, covered once every 3 to 5 years. Additional claims of these codes will typically result in payment for whatever is allowed for a D0120-Periodic Oral Evaluation. The patient pays the balance.

D9610-Therapeutic Parenteral Drug-Single Administration has undergone a major revision. The ADA description now states, “Includes single administration of antibiotic, steroids, anti-inflammatory drugs, or other therapeutic medications. This code should not be used to report administration of sedative, anesthetic or reversal agents.” In the CDT 2005-2006 the description included “injection of sedatives.” This version specifically omits this. A few dental carriers, under extremely limited circumstances, may provide a benefit for D9610. A narrative explaining what drug was administered, what the dosage was, and for what it was given would be helpful. Offices may also try D9230-Analgesia, Anxiolysis, Inhalation of Nitrous Oxide, or D9248-Non-Intravenous Conscious Sedation for sedative injections. Intravenous sedation may be reported using D9241-Intravenous Conscious Sedation/Analgesia-first 30 minutes and D9242-Intravenous Conscious Sedation/ Analgesia-each additional 15 minutes.

There are other notable changes to the Code for 2007-2008. Dentists and staff need to review and use the most current and descriptive codes available when reporting treatment for their patients.