For many dental practices, dental coding remains a vital chain in the link when it comes to code various dental procedures as well as for reimbursement. Accurate coding can be confusing at times since it entails a different set of codes similar to medical billing.
While medical coding is based on the Current Procedural Terminology (CPT), dental coding relies on Current Dental Terminology or CDT codes, which are maintained by the American Dental Association. The ADA keeps track of the codes which are important for most dental procedures and also in the dental claim process.
Even though CDT codes are part of every dental clinic, many dental professionals have never been formally trained in the code set and are not comfortable with using them. The gap can be attributed to the fact that CDT dental codes are solely associated with insurance companies, whereas they are procedure codes that come from the American Dental Association and is not the responsibility of the business team alone.
What is CDT?
CDT is a reference manual published each year by the American Dental Association, containing the CDT code set. It consists of procedural codes for all adjunctive and oral health services that are provided in dentistry.
Each procedural code in the CDT is made of an alphanumeric character starting with the letter D followed by a title, called the nomenclature. For some procedural codes, a short narrative or descriptor is also included.
The procedural codes are categorized into various services, which include preventive, diagnostic, restorative, oral surgery, orthodontics, endodontics, Implant services, fixed prosthodontics, removable prosthodontics, and more.
Purpose of CDT codes
According to the ADA, the CDT codes serve the purpose of achieving uniformity, consistency, and specificity in accurately documenting dental treatment.
The code set is also part of the HIPAA (Health Insurance Portability and Accountability Act) making it mandatory for the efficient processing of dental claims.
Any claim submitted on a HIPAA standard electronic dental claim must use dental procedure codes from the version of the CDT Code in effect on the date of service. The CDT Code is also used on paper dental claims, and the ADA’s paper claim form-data content reflects the HIPAA electronic standard.
CDT coding encourages dental professionals in the use of limited codes that can be assigned to any section or category of the CDT manual.
How CDT codes are determined in Dentistry
To start with, the patient must have opted for dental insurance to be eligible for assigning CDT dental coding for their services and procedures. If there is no dental insurance, insurance companies are not liable to pay for the cost that was rendered on the service or procedure. Many patients mistake that medical insurance also covers dental services, but that is not the case.
In some cases, dental care is performed in accordance with medical conditions. When that happens, the patient’s bills are processed under medical insurance. In these cases, insurance companies have to be informed and explained in detail about the dental services that were used under the specific medical conditions.
For example, if a patient has a cyst in the gums which have been incised and drained at the dental office, the procedure can either be billed as dental or medical. However, the dental coding and medical coding for the same procedure will be different. This means that patients with similar cases as explained in the example can either opt for dental billing or medical billing, but the billing will be with different insurance vendors for each.
Revisions and Updates
The American Dental Association convenes each year in the month of March to review the dental codes for the year. In 2021, there were a total of 156 ADA code change request, out of which 6 deleted codes. 5 revised codes and 37 new codes were added to CDT codes 2021.
Most of the updates in the code set concern 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.
Since CDT coding is essential for maintaining proper record and accurate claim submission, frequent coding revisions reduce the risk of fraudulent services while assuring compliance.
Choosing the appropriate CDT code
Depending on the dentist’s clinical decisions to perform procedures or services and by referencing the CDT manual to determine which dental procedure code should be used to document the service that was provided.
A procedure code entry consists of the code with its nomenclature, which are printed in boldface type. While some code entries also have descriptors printed in regular typeface. A careful reading of the code entry should provide the information needed for a dentist to decide which code most accurately describes the procedure that was performed. Codes should not be chosen based on what will gain the most reimbursement.
These articles served as a comprehensive guide to CDT codes and what purpose they serve in the dental business, as well as what they mean for the patients and the billing process. There are more technical resources available on the code set that can be used by dental offices to make their process streamlined and for accurate coding. At the minimum, there should be a copy of the current CDT book available at every dental office.
Health-care professionals have an obligation to ensure that the proper codes are documented for the procedures that they render so that the records are as accurate as possible. Moreover, it is important for both the clinical and business staff to understand the crucial role that CDT codes play in the overall communication, efficiency, and accuracy across all departments.