News & Events

Dental Claims: New Dental Procedure Codes for 2011-2012

by Tom Limoli
LIMOLI.com

The New Year brings about some rather unique as well as potentially troublesome issues. First off it will be the year I turn 50 and my stepdaughter will no longer be considered a pre-teen. Dr. Tom will have been gone 5 years while Penny and I are just beginning our journey together. Most of this cannot in any way be avoided or controlled. It must simply be appropriately managed. Brooke will soon be dating and driving. Dad's memories and life lessons will continue to strengthen. While our lives lived together will bring about new joys and challenges that make us all more ready for tomorrow. And speaking of challenges, we will have a whole new mess of both redefined and new changes to the Codes on Dental Procedure and Nomenclature.

Let's take a look into the future and briefly see what is in store for the next two years. Current Dental Terminology is available directly from the American Dental Association and my Dental Insurance and Reimbursement — Coding and Claim Submission Manual is available from www.LIMOLI.com.

REDEFINED

Diagnostic

Unless you own or are employed by a pathology laboratory the redefinition of D0486, once again, is going to have absolutely no impact on your day-to-day life.

Restorative

What was a sedative filling is still D2940 but it is now called a “protective restoration.” The descriptor is somewhat improved but it now contradicts D9110 while at the same time specifying its previous inappropriate usage for closing an endodontic access hole.

Endodontics

D3351 and D3352 apexification/recalcification codes have been clarified to more specifically address the interrelationship with new code D3354 pulpal regeneration so as to not add confusion concerning appropriate utilization. More on code D3354 will come later.

Periodontics

In summary D4263 and D4264 bone replacement grafts, D4266 and D4267 guided tissue regeneration, D4320 and D4321 provisional splinting all have grammatically as well as technique sensitive corrections to the descriptors.

Implant Services

Existing code D6055 implant connecting bar can now be used for both implant or abutment supported bars while D6950 precision attachment specifies that it is identified separately from the prosthetic.

Oral and Maxillofacial Surgery

Thankfully D7210 surgical extraction still requires removal of bone and/or sectioning of the tooth but now the mucoperiosteal flap is not longer required while D7953 bone replacement for ridge preservation and D7960 frenulectomy, frenectomy, and frenotomy have well needed updated descriptors.

Adjunctive

Of confusion is the redefinition of local anesthesia D9215 indicating its potential submission on benefit claims with both operative as well as surgical procedures? The future of the electronic health record notwithstanding, how many operative and surgical procedures are you doing without at least local anesthesia? This has the administrative nightmare of CDT-2005 written all over itself. Have we not learned from the past?

And now to top it all off, analgesia D9230 was redefined by simply reversing the order of the words in order to pacify Sister Mary Mucknfutz, my 4th grade English Composition teacher while D9420 now includes visits to ambulatory surgical centers as well as hospitals. What a relief…

NEW

Preventive

Preventive resin restorations in a permanent tooth will fall, or fail, under new code D1352. It does nothing more than simply identify when a sealant is still a sealant but can now be classified as being a “super sealant.” I will stand my ground and share with you today my personal observation that this ill intended and poorly designed CDT procedure code has the potential for health care fraud and inappropriate utilization abuse written all over it.

Endodontics

In the endodontic section code D3354 will be used for regenerating the damaged pulp of a necrotic, as opposed to neurotic, immature permanent tooth.

Maxillofacial Prosthetics

Want to see an emotionally challenged and previously help/hopeless patient's life change right before your eyes? Go back and give back to both the art and science of dentistry and spend some time with the artisans we all know as the maxillofacial prosthodontist. New code D5952 will be for adjusting a prosthetic appliance identified in the “D5900” section of the code. Also at their disposal is will be D5993 which identifies the cleaning and maintenance of those same appliances found in the “D5900” section of the code. These codes are not intended to identify the simple adjusting and cleaning of traditional full or partial dentures.

Prosthodontics, Fixed

In the fixed partial denture section, codes D6254 and D6795 can be used for identifying interim bridges when not entirely part of routine prosthetic services. As with any interim appliance, its intention is strictly to maintain the patient while healing, resolution, and other procedures are completing.

Oral & Maxillofacial Surgery

New to the oral surgery section is D7251 for identifying the intentional removal of only a portion of a tooth so as to not create a neurovascular complication while D7295 is for identifying only the harvesting of bone when it is going to be used in an autogenous grafting procedure.

If I can be of specific assistance to you and or your practice please feel free to contact me at www.LIMOLI.com.

Tom Limoli, Jr. is the prevailing expert on proper coding and administration of dental insurance benefit claims. He serves as president of Limoli and Associates, a company that over the past quarter century has assisted dental offices in streamlining the insurance reimbursement process. Mr. Limoli’s no-nonsense approach to the management of third-party reimbursement has been implemented in thousands of dental practices across the country. Customized fee schedule analysis for your individual office is available for a charge from Limoli and Associates / Atlanta Dental Consultants at (800) 344-2633 or www.LIMOLI.com.

About Apex EDI

Apex EDI is a leading healthcare claims clearinghouse for medical and dental professionals. Apex EDI serves thousands of physicians, dentists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. Founded in 1995, Apex EDI is based in American Fork, Utah.

Posted in: Dental Claims

Leave a Comment (0) →