25" CDT2018: Coding Companion Brush up on your team’s coding skills with the CDT 2018 Coding Companion. Revised for 2018, the Companion trains staff to code more accurately and efficiently, with key coding concepts, scenarios, and Q&A. Use the Companion, along with CDT 2018, to enhance the knowledge of current CDT 2018 staff or as an orientation tool for new employees. Take a chapter at a time to review at staff meetings or use it as a handy reference guide for common coding conundrums.
Companion includes: • 50+ coding scenarios • 100+ common coding Q&A • Descriptions of new CDT codes and revisions 8.25" • Tables linking CDT Codes with applicable ICD-10 Diagnosis Codes The Companion was developed with the oversight of the ADA’s Council Coding Companion on Dental Benefits and Practice to ensure the information is as accurate and up-to-date as possible. Organized by coding category, each chapter was written by a dental expert, including coding consultants, insurance administrators and practicing dentists. Help Guide for the Dental Team J448 To order additional copies, call 800.4746 or visit ADAcatalog.org ©2018 American Dental Association All rights reserved. CDT 2018 Coding Companion Help Guide for the Dental Team www.com Acknowledgements The ADA would like to acknowledge contributions made by the following individuals to this publication, in addition to the chapter authors: Editorial Panel – Council on Dental Benefit Programs’ Subcommittee on Codes Dr.
Thomas a’Becket; Dr. Christopher Bulnes; Dr. Douglas Gordon; Dr. James Hollingsworth; Dr.
Mark Mihalo; Dr. Cynthia Olenwine; Dr. Ronald Riggins; and Dr. Steven Snyder ADA Practice Institute – Center for Dental Benefits, Coding and Quality Dr.
Krishna Avaramudhan, Director, Council on Dental Benefit Programs; Frank Pokorny, MBA, Senior Manager, Dental Codes Maintenance and Development; and Stacy Starnes, Dental Codes Associate ADA Department of Product Development and Sales Kathy Pulkrabek, Manager/Editor, Professional Products and Carolyn Tatar, MBA, Senior Manager, Product Development We also want to acknowledge the permissions to reprint: • Artwork provided by Glidewell Laboratories used in the discussion of Implant procedures, which are captioned: “Image courtesy of Glidewell Laboratories.” • The ADA publication A Guide to Reporting D4346 (Copyright ©2017 American Dental Association) as Appendix 2. © 2018 American Dental Association. All rights reserved. All rights reserved.
No part of this book may be reproduced or transmitted in any form or by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval system) without permission in writing from the publisher. To order the current edition of this publication, please visit the American Dental Association’s online catalog at adacatalog.org or call 1.com CDT 2018 Coding Companion Table of Contents Section 1. The CDT Code: What It Is and How To Use It A Brief History. 3 Categories of Service.
5 Components of a CDT Code Entry. 5 What If There is No Code Describing a Procedure. 6 Narratives for “By Report” CDT Codes. 7 CDT Code Maintenance: Additions, Revisions and Deletions.
9 Dental Procedure Codes (CDT) and Diagnosis Codes (ICD).10 Dental Procedure Codes vs. Medical Procedure Codes. …12 Claim Rejection: Payer Misuse of the CDT Code or Something Else?.14 The “Golden Rules” of Procedure Coding.18 Code Changes in CDT 2018.19 Notable Changes: What and Why. Using the CDT Code: Definitions and Key Concepts, Coding Scenarios and Coding Q&A Introduction.33 By Mark Mihalo, D.59 By Paul Bornstein, D.
© 2016 American Dental Association www.com Chapter 3: D2000 – D2999 Restorative.83 By Ronald Riggins, D. 105 By Kenneth Wiltbank, D. 125 By Marie Schweinebraten, D. and Robert Rives, D.
Chapter 6: D5000 – D5899 Prosthodontics, Removable. 147 By Terry Kelly, D. Chapter 7: D5900 – D5999 Maxillofacial Prosthetics. 155 By Terri Bradley Chapter 8: D6000 – D6199 Implant Services.
165 By Linda Vidone, D.D Chapter 9: D6200 – D6999 Prosthodontics, Fixed. 189 By Teresa Duncan, M. Chapter 10: D7000 – D7999 Oral and Maxillofacial Surgery. 221 By Stephen Robirds, D.
Chapter 12: D9000 – D9999 Adjunctive General Services. 245 By Patti DiGangi, R. CDT Code to ICD (Diagnosis) Code Cross-Walk. A Guide to Reporting D4346.287 Index by CDT Code.com Section 1 The CDT Code: What It Is and How To Use It www.com Section 1 1 The CDT Code: The CDT Code: What It Is and How to Use It What It Is and How to Use It A Brief History The CDT Code was first published in 1969 as the “Uniform Code on Dental Procedures and Nomenclature” in the Journal of the American Dental Association.
It originally consisted of numbers and a brief name, or nomenclature. Since 1990, the CDT Code has been published in the American Dental Association’s dental reference manual titled Current Dental Terminology (CDT). The CDT Code version published in CDT-1 (1990) was marked by the addition of descriptors (a written narrative that provides further definition and the intended use of a dental procedure code) for most of the procedure codes. The American Dental Association is the copyright owner and publisher of the CDT Code.
New versions are published every year and become effective January 1st. Federal regulations and legislation arising from the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require all payers to accept HIPAA standard electronic dental claim. One data element on the electronic dental claim is the dental procedure code, which must be from the CDT Code — specifically the version that is effective on the date of service. Purpose The CDT Code supports uniform, consistent, and accurate documentation of services delivered.
This information is used in several ways: • To provide for the efficient processing of dental claims • To populate an electronic health record • To record services to be delivered in a treatment plan Note: Treatment plans must be developed according to professional standards, not according to provisions of the dental benefit contract. Always keep in mind that the existence of a procedure code does not guarantee that the procedure is a covered service. CDT 2018 Coding Companion: Help Guide for the Dental Team 3 www.com Categories of Service The CDT Code is organized into twelve categories of service, each with its own series of five-digit alphanumeric codes. These categories: • Exist solely as a means to organize the CDT Code • Reflect dental services that are considered similar in purpose • Contain CDT Codes that are available to document services delivered by anyone acting within the scope of their state law (for example, a dentist in general practice uses D7140 that is found in the oral and maxillofacial surgery category to document an extraction).
# Name Code Range Description in commonly used terms* Examinations, X-rays, pathology lab I. Diagnostic D0100-D0999 procedures II. Preventive D1000-D1999 Cleanings (prophy), fluoride, sealants Fillings, crowns and other related III. Restorative D2000-D2999 procedures IV.
Endodontics D3000-D3999 Root canals Surgical and non-surgical treatments of the V. Periodontics D4000-D4999 gums and tooth supporting bone Prosthodontics – VI. D5000-D5899 Dentures – partials and “flippers” removable Maxillofacial VII. D5900-D5999 Facial, ocular and various other prostheses.
Implant Services D6000-D6199 Implants and implant restorations Prosthodontics – IX. D6200-D6999 Cemented bridges fixed Oral & Maxillofacial Extractions, surgical procedures, biopsies, X. D7000-D7999 Surgery treatment of fractures and injuries XI. Orthodontics D8000-D8999 Braces Miscellaneous services including Adjunctive General XII.
D9000-D9999 anesthesia, professional visits, therapeutic Services drugs, bleaching, occlusal adjustment * The language used in the “Description” column has been simplified using common non-clinical terms. It is not technical terminology. 4 CDT 2018 Coding Companion: Help Guide for the Dental Team www.com Subcategories 1 All CDT Code categories of service are subdivided into one or more subcategories The CDT Code: What It Is and How to Use It to aid navigation through the code set. For example, subcategories in the Diagnostic category of service include: • Clinical Oral Evaluations • Diagnostic Imaging • Tests and Examinations Note: CDT Code entries are not always in numerical order within a category of service.
As the CDT Code grows and evolves, there are times when there is no sequential number available for a new entry that is related to an existing code. Components of a CDT Code Entry Every dental procedure code within a category of service has at least the first two and sometimes all three of the following components: Procedure Code – A five-character alphanumeric code beginning with the letter “D” that identifies a specific dental procedure. Each procedure code is printed in boldface type in the CDT manual and cannot be changed or abbreviated. Dental Procedure Code – five character alphanumeric beginning with “D” o D1351 sealant – per tooth Mechanically and/or chemically prepared enamel surface sealed to prevent decay Nomenclature – The written, literal definition of a procedure code.
Each code has a nomenclature that is printed in boldface type in the CDT manual. Nomenclature may be abbreviated only when printed on claim forms or other documents that are subject to space limitation. Any such abbreviation does not constitute a change to the nomenclature. Nomenclature (name) – written title of the procedure o D1351 sealant – per tooth Mechanically and/or chemically prepared enamel surface sealed to prevent decay CDT 2018 Coding Companion: Help Guide for the Dental Team 5 www.com Descriptor – A written narrative that provides further definition and describes the intended use of a dental procedure code.
A descriptor is not provided for every procedure code. Descriptors that apply to a series of procedure codes may precede that series of codes; otherwise a descriptor will follow the applicable procedure code and its nomenclature. When present, descriptors are printed in regular typeface in the CDT manual. Descriptors as published cannot be added, abbreviated or otherwise changed.
D1351 sealant – per tooth Mechanically and/or chemically prepared enamel surface sealed to prevent decay o Descriptor – N arrative providing further definition and describes the intended use of the procedure Descriptors are a very important component. Understanding the descriptor can help determine whether the procedure code accurately describes the service provided to a patient. This information can also help resolve questions about the accuracy of claim submissions. Note: Your practice management software may not include entire CDT Code entries as some, due to space limitations, truncate nomenclatures and omit descriptors.
With the current CDT Manual at hand you will have the complete entries for all CDT Codes, which will help you select the appropriate code to document and report the service delivered. What If There is No Code Describing a Procedure? The complete CDT Code entry, described above, published in the current CDT Manual is used to determine the procedure code for documenting and reporting a service provided to a patient. But, what if there is no CDT Code that, in the dentist’s opinion, is applicable to the service? The available and appropriate option is to use an “unspecified procedure, by report” code, also known as a “999” code., D2999 unspecified restorative procedure, by report) are in every category of service, and when used must include a supporting narrative that explains the service provided. A third-party payer may request additional documentation of certain procedures regardless of the presence of the narrative.
Note, too, that dental benefit plan coverage limitations and exclusions, and where applicable the provisions of a participating provider agreement, affect third-party payer claim adjudication and reimbursement. 6 CDT 2018 Coding Companion: Help Guide for the Dental Team Narratives for “By Report” Codes 1 There are two types of CDT Codes that require an explanatory narrative. The The CDT Code: What It Is and How to Use It first and most readily known type are the “unspecified…procedure, by report” codes found in every category of service. Second are those codes in several categories that include “by report” in their nomenclatures – as seen in the following two examples.
D5862 precision attachment, by report Each set of male and female components should be reported as one precision attachment. Describe the type of attachment used. D6100 implant removal, by report This procedure involves the surgical removal of an implant. When preparing a narrative report, first try and put yourself in the claim examiner’s position.