The CDT Code, short for Uniform Code on Dental Procedures and Nomenclature, was first published in 1969. The copyright owner and publisher of the CDT Code is the American Dental Association, and new versions are updated annually, becoming effective on January 1st. Federal regulations began requiring all payers to accept HIPAA electronic dental claims as a result of the Health Insurance Portability and Accountability Act of 1996.
The use of proper dental coding by dental staff is a must to facilitate accurate reimbursement from insurance plans. CDT coding assures uniform, consistent and accurate documentation of the dental services being delivered. The information from dental coding is used for several reasons:
- To provide for efficient processing of dental claims
- To populate an electronic health record
- To record services to be delivered in a treatment plan
Importance of Using Proper CDT Codes
Insurance companies constantly create new policy plans in an attempt to reduce their liabilities when making payments to dental practices. Dental practices sign contracts with these insurance companies to become “in-network” with a contracted fee schedule, and as a result agree to abide by the plan rules, which may or may not be in favor of the dentist or patient. Problems arise with these dental plan contracts when the insurance company has plans that have a variety of exclusions, limitations, etc. This can result in the insurance companies dictating dental treatments necessary and what can and cannot be covered according to their plan costs.
Is this in the best interest of the dental practice providing services to their patients? Sometimes the policies of these dental plans result in denied claims and a lack of quality care. This is due to prohibiting costs. As a result, proper dental coding is essential. Every time a dental team member uses an incorrect CDT code for a patient’s claim, the insurance companies win.
Five Codes Dental Hygienists Must Know
CDT Codes are not just for insurance claims! They are also procedure codes from the American Dental Association. It is used by dental hygienists who must be formally trained and familiar with them. Dental practices are bound to code for the procedures they render. This code becomes a part of the dental records for patients and must be properly documented. It is also important to remember just because there is a CDT code for the dental procedure, this does not mean it will be covered by the patient’s dental plan. Dental professionals do not use codes or base their treatment on what insurance will or will not cover because that is fraud. It is very important to get the proper consent or refusal before treatment of a patient and to make sure they know all the risks, benefits and costs before treatment is performed.
In addition, it is good to know the CDT codes that are under hygiene (radiographs, chemotherapeutics, sealants, fluoride, etc.). It may be also helpful if you enter treatment plans to know some basic restorative codes as well.
- D1110: Prophylaxis – Adult
- D1120 – Prophylaxis – Child
- D4346 – Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation
- A). D4355 – Full mouth debridement to enable a comprehensive oral evaluation and diagnosis on a subsequent visit. B). Periodontal scaling root planing: D4341 – 4 or more involved teeth in the quadrant; D4342 – 1 to 3 involved teeth in the quadrant
- D4910 – Periodontal maintenance
There are several sources available that provide more detail to help the front office communicate efficiently with the back office teams. The minimum your office should have available is a current ADA CDT book. As members of the healthcare profession, there is an obligation to be sure the proper codes are reported for the services performed on patients. This is required for the accuracy of records as well. It is in the best interest of the dental practice to have an understanding of the codes relative to our scope of practice. Both the dental practice as well as clinical staff must have a working relationship that promotes better communication, accuracy, and efficiency.
Dentists may not understand well the recent CDT Codes. The American Dental Association, as well as the Code Maintenance Committee and others from the dental community, have developed a variety of educational materials. The information is available for anyone to download, read or view online.
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