Code on D

ental Procedures and Nom

enclature

Dental Procedure Codes

CDT2017

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Restorative 1C

ode on Dental Procedures and N

omenclature

D2000-D2999 III. RestorativeLocal anesthesia is usually considered to be part of Restorative procedures.

Explanation of Restorations

Location Number of Surfaces

Characteristics

Anterior

1 Placed on one of the following five surface classifications – Mesial, Distal, Incisal, Lingual, or Facial (or Labial).

2 Placed, without interruption, on two of the five surface classifications – e.g., Mesial-Lingual.

3 Placed, without interruption, on three of the five surface classifications – e.g., Lingual-Mesial-Facial (or Labial).

4 or more

Placed, without interruption, on four or more of the five surface classifications – e.g., Mesial-Incisal-Lingual-Facial (or Labial).

Posterior

1 Placed on one of the following five surface classifications – Mesial, Distal, Occlusal, Lingual, or Buccal.

2 Placed, without interruption, on two of the five surface classifications – e.g., Mesial-Occlusal.

3 Placed, without interruption, on three of the five surface classifications – e.g., Lingual-Occlusal-Distal.

4 or more

Placed, without interruption, on four or more of the five surface classifications – e.g., Mesial-Occlusal-Lingual-Distal.

• Note: Tooth surfaces are reported on the HIPAA standard electronic dentaltransaction and the ADA Dental Claim Form using the letters in the following table.

Surface CodeBuccal BDistal DFacial (or Labial) FIncisal ILingual LMesial MOcclusal O

SAMPLE

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Periodontics 1C

ode on Dental Procedures and N

omenclature

D4000-D4999 V. PeriodonticsLocal anesthesia is usually considered to be part of Periodontal procedures.

Surgical Services (Including Usual Postoperative Care)

Site: A term used to describe a single area, position, or locus. The word “site” is frequently used to indicate an area of soft tissue recession on a single tooth or an osseous defect adjacent to a single tooth; also used to indicate soft tissue defects and/or osseous defects in edentulous tooth positions.

– If two contiguous teeth have areas of soft tissue recession, each area ofrecession is a single site.

– If two contiguous teeth have adjacent but separate osseous defects, eachdefect is a single site.

– If two contiguous teeth have a communicating interproximal osseous defect,it should be considered a single site.

– All non-communicating osseous defects are single sites.

– All edentulous non-contiguous tooth positions are single sites.

– Depending on the dimensions of the defect, up to two contiguousedentulous tooth positions may be considered a single site.

Tooth Bounded Space: A space created by one or more missing teeth that has a tooth on each side.

D4210 gingivectomy or gingivoplasty – four or more contiguous teeth or tooth bounded spaces per quadrant It is performed to eliminate suprabony pockets or to restore normal architecture when gingival enlargements or asymmetrical or unaesthetic topography is evident with normal bony configuration.

D4211 gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant It is performed to eliminate suprabony pockets or to restore normal architecture when gingival enlargements or asymmetrical or unaesthetic topography is evident with normal bony configuration.

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Implant Services 1C

ode on Dental Procedures and N

omenclature

D6000-D6199 VIII. Implant Services Local anesthesia is usually considered to be part of Implant Services procedures.

Pre-Surgical Services

D6190 radiographic/surgical implant index, by report An appliance, designed to relate osteotomy or fixture position to existing anatomic structures, to be utilized during radiographic exposure for treatment planning and/or during osteotomy creation for fixture installation.

Surgical Services

Report surgical implant procedure using codes in this section.

D6010 surgical placement of implant body: endosteal implant

D6011 second stage implant surgery Surgical access to an implant body for placement of a healing cap or to enable placement of an abutment.

D6012 surgical placement of interim implant body for transitional prosthesis: endosteal implant Includes removal during later therapy to accommodate the definitive restoration, which may include placement of other implants.

D6013 surgical placement of mini implant

D6040 surgical placement: eposteal implant An eposteal (subperiosteal) framework of a biocompatible material designed and fabricated to fit on the surface of the bone of the mandible or maxilla with permucosal extensions which provide support and attachment of a prosthesis. This may be a complete arch or unilateral appliance. Eposteal implants rest upon the bone and under the periosteum.

SAMPLE

15.437"

8.37

5

You and your dental team are first in line to ensure that patient records and claims are complete and accurate. The CDT 2017 Companion: Help Guide for the Dental Team is the go-to resource that gives you the information that helps your records and claims stand up to challenges.

The Companion features:

• Descriptions of what is new and changed in CDT 2017, and the reasonswhy codes were added or revised

• Guidance on CDT Code selection through coding scenarios and illustrationsin a Q&A format

• An in-depth look at narratives for “by report” codes

• Ways to identify and address possible CDT Code misuse when a payerrejects a claim

• Tables that link CDT Codes with applicable ICD-10 Diagnosis Codes,information that will be valuable when requested by third-party payers

Used in tandem with CDT 2017, the Companion is ideal to update current staff on CDT Code changes or use a training resource for new employees. Use it for staff meetings, quick training sessions, or as a reference guide to help your team code with skill and confidence.

CDT2017: Coding Companion: Help G

uide for the Dental Team

J447To order additional copies, call 800.947.4746 or visit adacatalog.org

©2016 American Dental Association All rights reserved.

Coding CompanionHelp Guide for the Dental Team

CDT2017

30 CDT 2017 Coding Companion: Help Guide for the Dental Team

In CDT 2017 two codes were added, none were revised, and one was deleted.

The first addition is for a procedure that makes use of new types of calibrated instruments that can better define decay in its early stages, without use of x-rays or other types of ionizing radiation:

D0600 non-ionizing diagnostic procedure capable of quantifying, monitoring, and recording changes in structure of enamel, dentin, and cementum

The second addition was created to fill a gap in the Tests and Examinations subcategory, where there is an entry for sample collection for culture and sensitivity testing (D0415), but no entry for processing the sample:

D0414 laboratory processing of microbial specimen to include culture and sensitivity studies, preparation and transmission of written report

One diagnostic imaging entry was deleted as a “housekeeping” action:

D0290 posterior-anterior or lateral skull and facial bone survey radiographic image

It was made redundant by a CDT 2016 revision to the D0250 entry, which reads as follows:

D0250 extra-oral – 2D projection radiographic image created using a stationary radiation source, and detector These images include, but are not limited to: Lateral Skull; Posterior-Anterior Skull; Submentovertex; Waters; Reverse Tomes; Oblique Mandibular Body; Lateral Ramus.

Changes to This Category

SAMPLE

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Using the C

DT C

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oncepts, Coding Scenarios and C

oding Q&

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II

CODING SCENARIO #8

Treating a Patient Suffering From Swelling, Pain and Periodontal Disease

A patient presented in pain and complaining about swelling around one particular tooth. The doctor’s emergency evaluation focused on the patient’s complaint and included two periapical radiographic images and pocket measurements of the teeth in the area. The swelling was clearly adjacent to tooth #3 and the sulcus gushed a purulent mixture of blood and pus when probed.

The doctor treated the patient for a periodontal abscess by gross debridement and draining through the sulcus, irrigating the pocket with Chlorhexidine and prescribing the patient an antibiotic.

How could this encounter be coded?

Since the evaluation was both problem-focused and limited to the patient’s complaint, the appropriate codes for diagnostic procedures would be:

D0140 limited oral evaluation – problem focused

D0220 intraoral – periapical first radiographic image

D0230 intraoral – periapical each additional radiographic image

In this case there are a number of codes that might be used to document the operative services, alone or in combination. Three possible procedure coding options are:

D9110 palliative (emergency) treatment of dental pain – minor procedure This is typically reported on a “per visit” basis for emergency treatment of dental pain.

Note: D9110 is a “catch-all” code that covers a broad array of procedures.

D7510 incision and drainage of abscess - intraoral soft tissue Involves incision through mucosa, including periodontal origins.

SAMPLE

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Using the C

DT C

ode: Definitions and Key C

oncepts, Coding Scenarios and C

oding Q&

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Introduction Endodontics utilizes the 3000 section of the CDT Codes. These codes concern procedures related to maintenance of the pulp, regeneration of the pulp and, of course, removal of the pulp and obturating the space where it previously existed. There are surgical codes that pertain to endodontics, including periradicular surgeries as well as use of bone grafting and bone regenerating materials.

Some of the main challenges and questions that are typical to Endodontics involve how to code for procedures when they are done in more than one appointment. Other frequently asked questions deal with what things are considered a part of the root canal and what things can be coded separately. For example, when to use codes D3331 (root canal obstruction), or D9630 (drugs dispensed in the office) for special endodontic irrigation at home, in conjunction with a root canal code in the claim. Another example would be, the question of which radiographs are a part of the root canal procedure and which can be separately coded. Separately, CDT Code entries for procedures that involve pulpal regeneration are clear, but they are less commonly used and can be confusing unless the process has been studied by the office coding specialist.

Chapter 4. D3000-D3999 EndodonticsBy Kenneth Wiltbank, D.D.S.

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ANESTHESIA: A patient’s level of consciousness is determined by the provider and not the route of administration of anesthesia. State dental boards regulate the use of anesthesia techniques. The ADA House of Delegates adopted and has published anesthesia policy and guidelines, which are available at ada.org/~/media/ADA/About%20the%20ADA/Files/anesthesia_use_guidelines.pdf?la=en.

CONSULTATION: In a dental setting, a diagnostic service provided by a dentist where the dentist, patient, or other parties (e.g., another dentist, physician, or legal guardian) discuss the patient’s dental needs and proposed treatment modalities.

MEDICAMENT: Substance or combination of substances intended to be pharmacologically active, specially prepared to be prescribed, dispensed or administered by authorized personnel to prevent or treat diseases in humans or animals.

MICROABRASION: Mechanical removal of a small amount of tooth structure to eliminate superficial enamel discoloration defects.

PALLIATIVE: Action that relieves pain but is not curative.

PARENTERAL: A technique of administration in which the drug bypasses the gastrointestinal (GI) tract. Examples of parenteral administration may include intramuscular (IM), intravenous (IV), intranasal (IN), submucosal (SM), subcutaneous (SC) or intraosseous (IO).

Key Definitions and Concepts

SAMPLE