Dental Billing & Coding Guidelines

Dental Billing & Coding Guidelines

Dental coding remains a crucial area for many dental practices. It counts the skill to code various procedures for proper reimbursements. Unlike medical billing, Dental coding involves a different set of codes.

At ZEE Medical Billing we are aware of medical coding. Which relies on CPT coding, Dental coding particularly uses Current Dental Terminology (CDT) coding which is primarily maintained by American Dental Association. It holds on to the codes that are essential for various dental procedures for dental claim submission.


Dental Billing & Coding Guidelines


CDT codes in Dental coding:

  • CDT codes in dental coding are codes utilized for different oral health and industry procedures.
  • These codes are alphanumeric and always start with the letter ‘D’ followed by the numbers.
  • Descriptions are also written for few dental procedural codes and a set of CDT codes in dental coding is viewed by the types of services provided.
Those services are:
  1. Diagnostic
  2. Preventive
  3. Restorative
  4. Periodontics
  5. Endodontics
  6. Removable Prosthodontics
  7. Implant services
  8. Maxillofacial prosthetics
  9. Fixed Prosthodontics
  10. Oral and maxillofacial surgery
  11. Orthodontics
  12. Adjunctive General Services

Are CDT codes essential in Dental Coding?

  • It’s hard to tell when to use CDT codes and CPT codes, as it totally depends on the type of insurance availed and to which the claim was actually billed.
  • Healthcare professionals usually have three types of options for insurance coverage. They are:
  1. Medical
  2. Vision
  3. Dental
  • CDT codes are used in dental coding procedures, If healthcare professionals submit their dental claims either in-network or out of network or HIPAA compliant and engaged in electronic transmission.
  • U.S Federal Government designated by these CDT codes as national terminology to use to report dental services on claims for private or third-party insurance companies.
  • CDT coding was also considered and also designated as a mandatory standard for electronic communication of dental services and procedures.

How CDT codes are determined by Dental Practices?

  • Firstly, to assign CDT dental coding for dental procedures and services, the patient must have to choose dental insurance.
  • If no, the insurance companies deny paying for the procedures or services rendered. The coverage will not support medical insurance.
  • Most of the patients misunderstand that medical insurance coverage also covers dental services. But actually, it’s not true.
  • Healthcare professionals or dental practitioners must pay attention to the insurance coverage that patients possess.
  • There are certain cases where dental care is performed according to medical conditions. Then there’s a chance for patients to bill it under medical insurance. But it’s not easy to have billed from insurance companies without explaining the procedure in detail and convince the need for such dental service under particular medical conditions. Like if the patient has an ulcer or cyst in the gums and they are incised and drained in the provider’s office, the procedure can be billed as either medical or dental.
  • The dental coding and medical coding for the same procedures are different. The dental code (CDT) for incision and drainage of abscess of intraoral soft tissue is D7510 whereas the medical code for the same procedure is 41800. This shows that the patient can either opt for dental billing or medical billing and also can go to a dental or medical office to receive the same diagnosis or treatment. But the billing would be with different insurance companies.
  • Most of the medical plans eliminate coverage for the procedures. Like involving teeth, the payer coverage terms also state that any connection with teeth that includes care, treatment, filling, removal, and replacement will not be paid either for the patient or dentist.
  • Some medical plans also cover few surgeries and dental implant issues. Typically, a dental claim is submitted, if it’s denied, the medical claim is submitted.

Procedure for submitting CDT codes:

  • If medical claims use CMS 1500 form to submit their claims, dental claims use the J400 form for the claim process.
  • The information required to be included in the claim form is:
  1. Tooth system
  2. Tooth surface
  3. Tooth number or letter
  4. Area of the oral cavity
  5. Procedure description
  6. Teeth information that’s missing
  • The above information is added to the dental claim form for submitting the claim. It’s also indicated when the dentist performs necessary procedures.

Updates on CDT Dental codes:

  • Every year in March American Dental Association holds a meeting to determine new dental codes for that year.
  • For 2020, there were about 156 ADA code change requests out of which 37 new codes, 5 revised codes, and 6 deleted codes are added to dental procedural codes of 2020 CDT dental coding.
  • Most of the CDT 2020 code changes relate to specific coding. The new dental code that applies to patients with dental needs is specially assigned for special treatment conditions that require modifications while rendering oral healthcare services.
  • CDT coding is also critical sometimes. Accurate and uniform dental code assignment helps dentists to maintain proper records and accurate claim submission. It is directly related to the continuous reimbursements for dental services without any delay.
  • Regular coding reviews can reduce the risk of fraudulent services while assuring compliance.

New codes for Dental Coding

  • D0419: Assessment of salivary flow by measurements.
  • D5284: Removable unilateral partial denture and one-piece flexible base including claps and teeth per quadrant.
  • D2753: code for the crown, titanium as well as titanium alloys.
  • D5286: Removable unilateral partial denture and one-piece resin including claps and teeth per quadrant.
  • D6082: code for implants supported by crown, porcelain fused to predominant base alloys.
  • D6083: code for implants supported by crown, porcelain fused to noble alloys.
  • D6084: code for implants supported by crown, porcelain fused to titanium or titanium alloys.
  • D6086: implants supported by the crown and predominant base alloys.
  • D6087: implants supported by the crown and noble alloys.
  • D6088: implants supported by crown and titanium alloys.

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