Tips On Dental Coding

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Tips On Dental Coding
Some Coding Facts
• There are 500 procedures in Dental
• 90 procedures on average are done in the
dental office.
• If you are a “referadontist” – meaning you
send out a lot of procedures then you only use
60 procedures not the 90 average.
Clean up your coding!
• Delete or inactivate the deleted codes
• Enter only the new codes that specifically
apply to your practice.
• Delete inactive codes
Did you know there’s a new code for
sectioning a failed bridge in which the good
retainer is left indefinitely in the mouth?
D9120
An Extraction (D7140) of the failed
retainer with pontic should be
reported in addition to D9120
Extra Lab Procedures w/Partial D2971
this is an extra lab procedure required to make the
new crown fit the existing partial denture
Did you miss this code?
The lab usually charges you $50-$70
extra.
Bill crown (regular fee) plus D2971
(typical fee $150) on the seat date.
Are you coding out Core Buildups (D2950)
separately & raising the crown fee (which leaves
money on the table).
The PPO’s limit the crown fee and the buildup could
have been paid with proper documentation and
narrative!
The average DDS reports various types of buildups on
43% of the crowns & crown retainers.
Fluorides
• Effective 1/1/13 use D1206 for Fluoride
Varnish applications, regardless of caries risk.
• D1208 is for any Fluoride other than varnish
like Fluoride trays etc…
Effective 1/1/13 D1203 & D1204 are deleted –
your only choices are D1206 & D1208.
• Fluoride varnish should be used as the
type of fluoride for all patients!
• Most effective is D1206
Are you not reporting the Comprehensive Periodontal
Evaluation for new patients at all?
D0180
• D0180 typically reimburses better than D0150
& has a higher UCR allowance.
• However, to report D0180 the patient must be
either a perio patient (4-5mm pocket depths,
BOP, and some bone loss) OR
• Have risk factors for periodontal disease such
as diabetes, smoking or heart disease.
• In addition, a full mouth probing & charting is
mandatory to report D0180
Do you have high emergency evaluation (D0140)
counts while your pallative (D9110) counts are low?
• While D0140 can always be reported at an ER visit, it
remains subject to the “two evaluations a year” rule. If
D0140 is reported in conjunction with definitive
treatment (such as fillings, extractions, rc, etc.), often
D0140 is NOT reimbursed. However, if the doctor only
uses one evaluation a year (checking recall once and
not twice) then a second ER evaluation would probably
be paid.
• The general objective is for the D0140 counts to be
lower while pallative (D9110) counts should be higher.
• Generally pallative (D9110) has a higher UCR than
D0140.
Pallative – D9110
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At emergency visit
Minor procedures only
Smooth sharp corner of tooth
Adjust occlusion for pain relief
Remove decay, IRM placed
Desensitize tooth
Open tooth – partial debridement
Lance abscess for pain relief
Partial heavy calculus debridement (only with patient
complaint of discomfort)
• Apthous ulcer relief
Pallative – 09110 continued
• One of the least reported codes
• Typically allowed up to 2 times per year
• Cannot report any other treatment on same
visit date with most plans
• Xrays are OK
• Always use the narrative
• Auto rejection of this code if you do not
provide a narrative.
Do you take single BWX’s at a ER visit? This will
use up your annual 4 BWX coverage
• Look at your single film counts – the count
should be close to zero.
• Instead, consider two PA’s at the ER visit,
which are almost always clinically justified and
paid!
The Coronal Remnant Code
D7111 mistake
• This is NOT for routine baby tooth extraction
• It is only for the coronal remnant (piece of the
shell of the crown)
• D7140 is reported when the primary tooth has
a full crown & any root remains.
• UCR is higher for D7140 than D7111
• Many times it is miscoded as D7111
New Code D2929
• This is a new code for Primary Tooth PreFabricated Crown
• Must be a ceramic crown only!
New Code D2990
• This is for the Icon Resin Infiltrant
• This is a product used for incipient caries and
white spot lesions.
• It is microinvasive technology that fills,
reinforces and stabilizes demineralized enamel
without drilling or sacrifacing health tooth
structure.
• Excellent product by DMG America
Onlays
• Onlays can be reimbursed with excellent
documentation (photos, xrays, need for a
crown etc…)
• To be considered an onlay the cusp(s) must be
“capped” or “shoed”. An onlay always involves
the facial and/or lingual surfaces.
• MOF, MOL, MODFL – all okay
Are you reporting 2BWX when 4BWX should be
reported when 2nd molars have erupted?
• If so, lots of money is left on the table!
• If you have a higher count for 2BWX than
4BWX in your adult practice then money is left
on the table!
Do you rarely code a surgical extraction (D7210) for
an erupted tooth & use (D7140) for all extractions?
• The UCR of D7210 pays 50% to 100% more
than D7140.
• D7210 should document that bone was
removed or the tooth was sectioned.
• A flap is not required but optional starting
1/11/11.
Is one recall evaluation (D0120) reported
annually when two are generally payable?
• Most policies pay either 2 evaluations a year 1
evaluation per six months, so reimbursement
is available!
• However, if the doctor is checking multiple
hygienists and only wants to check recall
patients once a year, then once a year is OK.
Do you use two surface fillings (D2331) for the incisal
edge of an anterior tooth when it is always four
surfaces (D2335) – MIFL or DIFL?
• If you have a low procedure count of code
D2355 it’s a tip off.
• For incisal edge of the tooth, the surfaces
would be one, two, or three depending on the
dentists preparation of the tooth.
Are you coding out a perio bone graft (D4263/D4264)
(associated with osseous surgery and natural teeth)?
• The graft is actually a bone socket graft
(D7953) done in conjunction with an
extraction!
Lab Relines (D5750-D5761) versus Chairside
Relines (D5730-D5741)
• You can use the lab reline (which pays more)
instead of the chairside reline if a triad oven or
pressurized water bath is used to process the
denture in the dental office
Immediate Denture Info
• Do you know that the immediate denture
(higher fee) is reported upfront and that later
a reline/rebase is paid if the proper waiting
period is observed?
• Can be up to 6 months after the extraction
date, to the day.
• Do not include the reline/rebase fee in the
immediate denture fee.
Standard denture versus implant supported denture
• Many offices report a standard denture when
they are really doing an implant supported
denture.
• The implant supported denture has a higher
fee allowed, if controlled by a PPO plan.
• This generally results in a lower write-off!
Are you reporting standard denture when you
are really doing an implant supported denture?
• The implant supported denture has a higher
fee allowed, if controlled by a PPO plan.
• This generally results in lower write-off.
Are you charging for a standard crown when it is
really an implant crown?
• This can be fraud, if done to get a better
benefit.
• However, generally with PPO’s, a higher fee is
allowed by charging out an implant crown,
which is a better benefit.
Are you charging a high global fee for an implant
crown?
• PPO’s knock down the fee substantially
• You should charge out separately for the
abutment
• Either a prefab abutment (D6056) or
• Custom abutment (D6057)
Abutment-supported codes
• You probably are not aware that abutmentsupported codes should be reported instead
of implant supported codes if an abutment
(D6056 or D6067) is involved.
• If an abutment is not involved, charge out the
implant-supported codes, which are not
generally done by most offices.
Occlusal Guard Info
D9940
• Occlusal Guards are paid about 35% of the
time with the proper narrative.
• Mention “bruxism” and “perio case”, if
applicable.
• This is NOT TMJ – (D7880)
Tooth Whitening Info
• Tooth whitening is a per arch code!
• Code out upper arch D9972 at half the total
fee
• Code out lower arch D9972 at half the total
fee
• Effective 1/1/13 – D9972 in only for in-office
whitening
• New Code D9975 is for at home trays/strips
You can take a pan starting at age 6
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Use pan to illustrate growth & development
For marketing – (parent shows other parents)
This leaving money on the table!
Much less radiation in today’s Pans than an
FMX!
D7465 Laser Code
• Destruction of Lesion by Laser
• May pay some of the time!
D7288 Oral CDX Biopsy
• Attach the pathology report to get paid
D8210 Removable Appliance Therapy
• This can ONLY be used for thumb sucking!
D0431 Oral Cancer Screening Code
• Must be 18 years and older to bill for this
screening
• 6%-7% of insurance carriers will pay presently
but more will start to join slowly as oral cancer
rate is on a steady rise due to HPV.
• This is done once per year.
Purchase the new CDT-2015 Book today!
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Coding With Confidence
The “go to” dental insurance guide
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