Dental technology is constantly evolving, which means patient care techniques are changing too. While it can be daunting to keep everything straight, there are tools to make sure you stay up to date with the most important innovations.
Besides allowing you to deliver the best possible patient care, keeping current on dental technology can help you avoid billing errors and make you a more marketable candidate for dental practices. Here are a few of the most important updates to keep in mind.
Consult the source of truth
Every year, the American Dental Association (ADA) publishes the Code on Dental Procedures and Nomenclature, otherwise known as the CDT code, that contains the most up-to-date terminology for dental services. This terminology is used to submit accurate claims to insurers. The CDT is revised annually and is available as a book, e-book, or mobile app. Its coding companion book comes with case studies that use multiple codes for patient scenarios to illustrate how the various procedure codes can and should be used.
Every dental procedure code entry in the CDT code is labeled with five alphanumeric characters and begins with the letter D. Following this procedure code is the nomenclature, which is the title of the procedure. Some entries also contain a descriptor, which is a short narrative that explains the use of a given code, and is required when a CDT code includes the phrase “by report.”
The CDT code is divided into service categories for easy navigation. Considering how important it is to submit the correct procedure codes for billing and insurance claims, always consult the code book when in doubt.
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Become familiar with these procedure codes
There are certain procedures that hygienists perform regularly. The codes for those procedures deserve special attention and familiarization. Here’s a rundown of the codes hygienists should keep top of mind.
In 2021, there was an update to the D1110 code that includes the removal of plaque, calculus, and stains from tooth surfaces and implants. This procedure is intended to control irritational factors and is a preventive, not therapeutic, procedure.
Code D4346 is for “scaling in presence of generalized moderate or severe gingival inflammation.”This is a full-mouth code used when treating gingival disease in the absence of clinical attachment loss. If radiographic evidence of bone loss exists, this is not the proper code to use.
The D4355 code is “full-mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit,”1 and it’s becoming less popular for a few reasons. Patients often do not return for a proper evaluation and diagnosis because they think they received an appropriate cleaning and do not understand that a comprehensive exam was not completed. Today, digital radiographs and AI imaging interpretation applications make it easier to detect clinical attachment loss in the absence of the full-mouth probe at the initial exam. However, it is still necessary to complete a comprehensive periodontal chart, and this can be done at the same visit as the periodontal scaling. Simply increase the appointment time to include the assessment.
Take note of codes D4341 and D4342. There are instances in which a patient may have generalized gingivitis and localized periodontitis. Documentation should include that active disease is present and should state which teeth or quadrant received root planing. The number of teeth with active periodontal infection, radiographic bone loss, or clinical attachment loss will determine whether the patient needs D4341 or D4342 in each quadrant.
To use code D4910 regarding periodontal maintenance, there must be evidence that prior active therapy such as scaling and root planing was completed. Because periodontal disease is episodic in nature, managing the disease long term may require active therapy when the disease is active. As stated within the perio maintenance code description, perio maintenance allows for “site specific scaling and root planing where indicated.” This is a primary difference between a prophylactic cleaning and a periodontal maintenance. Explaining this to patients will help them understand the difference because they often ask why they can’t return to “regular cleanings.”
Code D6080 is used when an implant supported fixed prosthesis is removed for cleansing both the prosthetic and the supporting implants. The procedure includes cleansing and examination of all aspects of the implant system, including occlusion and fit of the prosthetic(s). This code is used per appointment, not per prosthesis.
Finally, code D6081 is an implant code used when there is inflammation or mucositis associated with a single implant. This is a per implant code and requires a supportive narrative, along with radiographs and pocket charting when submitting for insurance reimbursement.
It is important to note, if the patient’s insurance does not provide for implant coverage, there will likely be no coverage for implant maintenance.
Knowing your codes has major benefits
Knowing your codes can help your dental practice avoid billing errors, potential write-offs, and unhappy patients. The codes discussed here are only a small slice of all the procedure codes you may perform at some point during your hygiene career. However, having a working understanding of some of the most common or tricky codes can make your job, and the overall patient experience, much smoother. Hygienists are lifelong learners, so keeping up with the CDT codes is an important piece of your learning journey.
1. 2023 CDT Code book