Find out about the new changes and their potential impact on your insurance billing practices and practice revenue.
The ADA’s Code Maintenance Committee (CMC) is responsible for maintaining the code on Dental Procedures and Terminology (CDT), the standardized language for the dental profession. These codes allow dental teams to clearly communicate with patients regarding proposed dental treatment, accurately document the services performed, appropriately bill for services, and communicate correctly with third-party payors about the dental treatment submitted for reimbursement.
The CMC meets annually to review, discuss, and vote on all submitted CDT code changes. At this meeting, the CMC chooses to accept, amend, or decline requests based on the combined best interests of the profession, patients, and payors. This article reviews a few of the most notable new codes added to CDT 2019.
Blood Glucose Level Testing
- D0412 blood glucose level test – in-office using a glucose meter
This procedure is used to document a patient’s blood glucose level at the time of sample collection. Many dentists perform a blood glucose test for diabetic patients prior to performing complex dental procedures to avoid a possibly life-threatening event. Code D0412 provides the means to properly document this test even when there is not a charge for the test. A dental plan may exclude D0412 from coverage; however, medical plans do typically consider reimbursement for blood glucose testing.
A dental practice may be subject to Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations if the practice performs a blood glucose test even if there is no charge to the patient or claim submitted for the service. Additionally, a state dental board may consider a blood glucose test outside of the scope of dental practice. Therefore, it is important to check with your state dental board and CLIA rules and regulations prior to implementing blood glucose testing in your practice.
Arch Treatment for Partial Dentures
- D1516 space maintainer – fixed – bilateral, maxillary
- D1517 space maintainer – fixed – bilateral, mandibular
- D1526 space maintainer – removable – bilateral, maxillary
- D1527 space maintainer – removable – bilateral, mandibular
- D5282 removable unilateral partial denture – one-piece cast metal (including clasps and teeth), maxillary
- D5283 removable unilateral partial denture – one piece cast metal (including clasps and teeth), mandibular
The codes listed above have been added to CDT 2019 to distinguish the arch treated for partial dentures. This was necessary because the CDT 2018 space maintainer codes and removable unilateral partial dental codes did not indicate the specific arch treated. Note that with the addition of these new codes, the CMC also removed three related codes from CDT 2019:
- D1515 space maintainer – fixed – bilateral
- D1525 space maintainer – removable – bilateral
- D5281 removable unilateral partial denture – one piece cast metal (including clasps and teeth)
Add Metal Substructure to Denture
- D5876 add metal substructure to acrylic full denture (per arch)
Previously, there was no code to adequately describe the addition of a metal substructure to strengthen a new or repair an existing complete denture. The addition of code D5876 provides more accurate documentation, reporting, and claims adjudication. Some plans may continue to consider the addition of a metal substructure inclusive to the fee of the newly fabricated denture while other dental plans may consider this procedure as a separate benefit. A dental plan may consider reimbursement when a metal substructure is added to repair a broken denture base. D5876 must be used to report a metal substructure only and not any other type materials.
Temporomandibular Joint (TMJ) Dysfunction Therapies
- D9130 temporomandibular joint dysfunction – non-invasive physical therapies
This new code covers therapy including, but not limited to, massage, diathermy, ultrasound, or cold application to provide relief from muscle spasms, inflammation or pain, intending to improve freedom of motion and joint function. This should be reported on a per-session basis.
The non-invasive treatment of TMJ disorders may include various modalities of physical therapy, the outcomes of which are pain management and muscle relaxation of the TMJ and its supporting structures. Examples of modalities used to perform this procedure may include but are not limited to transcutaneous electrical nerve stimulation, application of cold gel pack, infrared laser treatment, chiropractic manipulation, and so forth. While this code is broad in terms of how the procedure is performed, the code is selected based on the procedure performed and outcome of treatment.
A dental plan may exclude physical therapy treatments for TMD/TMJ; however, reimbursement may be available under the patient’s medical plan. Medical plans typically allow reimbursement when treatment is performed by a licensed physical therapist; therefore, coverage under different medical plan may vary for physical therapy services rendered by a dental provider.
Sustained Release Therapeutic Drug
- D9613 infiltration of sustained release therapeutic drug – single or multiple sites
One of the most notable additions to CDT 2019 is D9613 for infiltration of a sustained release therapeutic drug at single or multiple sites. Dentists and patients alike are actively seeking alternatives for using opioids to control acute pain after treatment, thus decreasing the risk of drug abuse and addiction. This new code describes and documents the use of an FDA-approved non-opioid medication to relieve acute pain, post-operative. Anticipate reimbursement to vary greatly among dental plans.
Three New Occlusal Guards
- D9944 occlusal guard – hard appliance, full arch
- D9945 occlusal guard – soft appliance, full arch
- D9946 occlusal guard – hard appliance, partial arch
These three new codes were added to cover different types of removable dental appliances designed to minimize the effects of bruxism or other occlusal factors. These codes are not to be reported for any type of sleep apnea, snoring or TMD appliances. The CDT 2018 code D9940 occlusal guard, by report did not specify full or partial arch nor indicate the type of guard, hard or soft. The addition of D9944, D9945, and D9946 eliminates the need for “by report” and allows for more accurate reporting of the actual procedure performed resulting in more accurate reimbursement consideration.
The descriptors of these new occlusal guard codes clearly indicate that these appliances are provided to minimize the effects of bruxism and other occlusal issues and are not to be reported for appliances used to treat sleep apnea, snoring, and TMD conditions.
Remember that just because a CDT code exists (new or established), this does not mean it will automatically be reimbursed by payors. While payors are required to recognize current CDT codes when submitted on claims, they are not required to pay them. When establishing dental benefits for their employees, employers are offered extensive options, so each plan can be very different. Plans vary, and dental services covered by one patient’s dental plan are not necessarily covered by another.
It is very important that doctors and dental teams remain current with all annual CDT code changes. New, revised, and deleted codes for CDT 2019 will go into effect on January 1, 2019. The CMC will continue to meet annually to consider necessary CDT code set additions, revisions, and deletions to make sure the existing code set is usable.
Code changes to CDT 2019 include 15 new codes, 5 revised codes, and 4 deleted codes. This article reviews a few of the new codes added to CDT 2019. Please visit www.practicebooster.com to learn more about my coding and administration resources.
Dental offices on a Customer Service Plan using one of these supported Dentrix versions will have the update available through the Update Manager.If you are not currently on a Customer Service Plan, call (800) 336-8749, option 1 or visit www.dentrix.com/servicebundles to learn more.
For more information about managing your business with Dentrix, visit https://www.dentrix.com/solutions/business-management.
By Dr. Charles Blair
Dr. Charles Blair is dentistry’s leading authority on practice proﬁtability, fee analysis, insurance coding strategies, and overhead control. He has individually consulted with thousands of practices, helping them identify and implement new strategies for greater productivity and proﬁtability. Dr. Blair’s extensive background and experience make him uniquely qualified to share his wealth of knowledge with the dental profession. A widely-read and highly-respected author and publisher, Dr. Blair offers four publications, Coding with Confidence, Administration with Confidence, Medical Dental Cross Coding with Confidence, and the Insurance Solutions Newsletter. He also created the CDT Code Advisor at www.practicebooster.com, which offers practical guidance for the real-world application of CDT codes. Dr. Blair holds degrees in accounting, business administration, mathematics, and dental surgery.
Originally published in Dentrix Magazine, Winter 2018