Dental Benefits and Insurance Issues

Dental Benefits and Insurance Issues

The AAPD Council on Dental Benefits Programs (CDBP) develops proposals at the behest of the AAPD Board of Trustees for new dental procedure codes, revisions and clarifications for consideration in the most current version of CDT Code on Dental Procedures and Nomenclature development process.

CDT 2009-2010 was released in October 2008. The revisions and additions included in this edition will be effective on January 1, 2009.

There were no code deletions for this edition. Additions and revisions to the Code on Dental Procedures and Nomenclature for CDT 2009-2010 are as follows:

Four New Codes
  • D0147 - collection and preparation of saliva sample for laboratory diagnostic testing
     
  • D0418 - analysis of saliva sample Chemical or biological analysis of saliva sample for diagnostic purposes.
     
  • D3222 - partial pulpotomy for apexogenesis -
    permanent tooth with incomplete root development

    Removal of a portion of the pulp and application of a medicament with the aim of maintaining the vitality of the remaining portion to encourage continued physiological development and formation of the root.
     
  • D5991 - topical medicament carrier A custom fabricated carrier that covers the teeth and alveolar mucosa, or alveolar mucosa alone, and is used to deliver topical corticosteroids and similar effective medicaments for maximum sustained contact with the alveolar ridge and/or attached gingival tissues for the control and management of immunologically mediated vesiculobullous mucosal, chronic recurrent ulcerative, and other desquamative diseases of the gingival and oral mucosa.
Revisions relevant to pediatric dentistry
 
Strikethrough indicates deletions, underlined text indicates additions.
Preface to Clinical Oral Evaluations

The codes in this section recognize the cognitive skills necessary for patient evaluation. The collection and recording of some data and components of the dental examination may be delegated; however, the evaluation, which includes diagnosis and treatment planning, is the responsibility of the dentist. As with all ADA procedure codes, there is no distinction made between the evaluations provided by general practitioners and specialists. Report additional diagnostic and/or definitive procedures separately.

  • D0145 Oral evaluation for a patient under three years of age and consultation with primary caregiver
    Diagnostic and preventive services performed for a child under the age of three, preferably within the first six months of the eruption of the first primary tooth, including recording the oral and physical health history, evaluation of caries susceptibility, development of an appropriate preventive oral health regimen and communication with and counseling of the child’s parent, legal guardian and/or primary caregiver.
    Note: The CRC intends that this procedure code is not an oral evaluation as defined by existing procedure code nomenclatures and descriptors (e.g., D0150; D0120).
     
  • D1203 - topical application of fluoride (prophylaxis not included) - child
    Used when reporting prophylaxis and fluoride procedures separately
     
  • D1204 - topical application of fluoride - (prophylaxis not included) - adult
    Used when reporting prophylaxis and fluoride procedures separately
     
  • D3220 - therapeutic pulpotomy - (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament
    Pulpotomy is the surgical removal of a portion of the pulp with the aim of maintaining the vitality of the remaining portion by means of an adequate dressing.

    • To be performed on primary or permanent teeth.
       
    • This is not to be construed as the first stage of root canal therapy.
       
    • Not to be used for apexogenesis.

     
  • Anesthesia codes D9220-D9248 now include this statement of clarification: The level of anesthesia is determined by the anesthesia provider’s documentation of the anesthetic’s effects upon the central nervous system and not dependent upon the route of administration.
The AAPD will sponsor a code workshop on CDT-2009/2010 at the AAPD 62nd Annual Session in Honolulu on May 23, 2009. Look for more information in the January 2009 issue of Pediatric Dentistry Today.

The process for CDT-2011/2012 has already begun with the next submission deadline of April 1, 2009. Any AAPD member interested in a new or revised code (nomenclature and/or descriptor) for CDT-2011/2012 is encouraged to contact CDBP Chair Dr. Jennifer Hendershot at (312) 890-4864 or jennifer_hendershot@hotmail.com. The AAPD CDBP can review the recommendation and consider an official submission from the AAPD. In general, the CRC accords greater weight to proposals submitted by professional organizations such as dental specialty associations like the AAPD.

For further information contact Dental Benefits Manager Mary Essling at (312) 337-2169 or messling@aapd.org.

*: The CRC is a deliberative body with equal representation from third party payers and the ADA.
 


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