How to Improve your Production Coding...
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How to Improve your Production Coding 2017 – The primary purpose of CDT is to provide dental teams with a standardized language to report dental procedures. This standardized language allows doctors to: »» Clearly communicate with patients about proposed dental procedures. »» Accurately document all dental services performed. »» Appropriately bill patients for services. »» Accurately report dental procedures to third-party payers. D0414 Laboratory processing of microbial specimen D0415 Collection of microorganisms for culture and sensitivity (D0415) is reported when testing the type and concentration of bacteria. D0417 collection and preparation of a saliva sample for laboratory diagnostic testing. D0418 analysis of a saliva sample for diagnostic purposes. D0600 Non- ionizing diagnostic procedure trans illumination technology is the DEXIS CariVuTM caries detection device. This device assists in diagnosing caries during the doctor ’ s oral evaluations. D1575 Distal shoe space maintainer – fixed – unilateral A distal shoe space maintainer is utilized following the premature loss or extraction of a primary second molar to guide the unerupted, permanent first molar into the proper arch position. These space maintaining appliances may be placed immediately following the extraction of the primary second molar or at a subsequent appointment. This type of fixed space maintainer extends subgingivally and distally to guide the proper eruption of the first permanent molar. existing code D1510, space maintainer – fixed – unilateral, does not accurately describe a distal shoe space maintainer that extends subgingivally and distally to guide the eruption of the first permanent molar. D4346 Scaling in presence of generalized moderate or severe gingival inflammation
Transcript of How to Improve your Production Coding...
How to Improve your Production Coding 2017
– TheprimarypurposeofCDTistoprovidedentalteamswithastandardizedlanguageto
reportdentalprocedures.Thisstandardizedlanguageallowsdoctorsto:»»Clearlycommunicatewithpatientsaboutproposeddentalprocedures.»»Accuratelydocumentalldentalservicesperformed.»»Appropriatelybillpatientsforservices.»»Accuratelyreportdentalprocedurestothird-partypayers.
D0414 Laboratory processing of microbial specimen
D0415 Collectionofmicroorganismsforcultureandsensitivity(D0415)isreportedwhentestingthetypeandconcentrationofbacteria.
D0417 collectionandpreparationofasalivasampleforlaboratorydiagnostictesting.
D0418 analysis of a saliva sample for diagnostic purposes.
D0600 Non- ionizing diagnostic procedure
transilluminationtechnologyistheDEXISCariVuTMcariesdetectiondevice.Thisdeviceassistsindiagnosingcariesduringthedoctor’soralevaluations.
D1575 Distal shoe space maintainer – fixed – unilateral
Adistalshoespacemaintainerisutilizedfollowingtheprematurelossorextractionofaprimarysecondmolartoguidetheunerupted,permanentfirstmolarintotheproperarchposition.Thesespacemaintainingappliancesmaybeplacedimmediatelyfollowingtheextractionoftheprimarysecondmolaroratasubsequentappointment.Thistypeoffixedspacemaintainerextendssubgingivallyanddistallytoguidethepropereruptionofthefirstpermanentmolar. existingcodeD1510,spacemaintainer–fixed–unilateral,doesnotaccuratelydescribeadistalshoespacemaintainerthatextendssubgingivallyanddistallytoguidetheeruptionofthefirstpermanentmolar.
D4346 Scaling in presence of generalized moderate or severe gingival inflammation
fullmouth,afteroralevaluation Theremovalofplaque,calculusandstainsfromsupra-andsubgingivaltoothsurfaceswhenthereisgeneralizedmoderateorseveregingivalinflammationintheabsenceofperiodontitis.Itisindicatedforpatientswhohaveswollen,inflamedgingiva,generalizedsuprabonypockets,andmoderatetoseverebleedingonprobing.Shouldnotbereportedinconjunctionwithprophylaxis,scalingandrootplaning,ordebridementprocedures. rationaleforaddingD4346:Perhapsoneofthebiggestdebatesinthedentalcodingarenaconcernstreatmentsthataremorecomplexthanatypicalprophylaxis,butdonotqualifyasperiodontaltreatmentorevenfullmouthdebridement.Inordertoqualifyforscalingandrootplaning(SRP),D4341orD4342,thepatientmusthaveradiographicevidenceofboneloss,pocketdepthsof4mmormore,andbleedingonprobing,indicatingactiveperiodontaldisease.Additionally,fullmouthdebridement(D4355)isjustifiedwhenanoralevaluationcannotbeperformedduetoexcessivecalculus,heavyplaque,anddebrisbuildup. Whenapatientpresentswithmoderateorseveregingivalinflammationbutnoboneloss(andanoralevaluationcanbesuccessfullyperformed)thetimeandeffortneededtotreattheconditionareoftenwellbeyondastandardprophylaxis.However,reportingeitherSRPorgrossdebridementisconsideredinappropriate,sincethepatient(withgingivitis)typicallydoesnothaveallthesignsandsymptomsrequiredtoreporteitherofthesecodes.Thus,thereisnoexistingcodethataccuratelyreportstheadditionaltimeandeffortrequiredtotreatthepatient’smoderateorseveregingivalinflammation. Duetotheextensivedebateandlackofagreementregardinghowtoaccuratelydescribethetreatmentofthistypeofcondition,theCMCformedaworkgroupmadeupofrepresentativesfromtheAmericanAcademyofPeriodontology(AAP),AcademyofGeneralDentistry(AGD),ADA,andvariousdentalpayers.Thisworkgroupspentasignificantamountoftimeandeffortcraftingacodewithanomenclatureanddescriptorthatadequatelydescribesthetreatmentofapatientwhopresentswithmoderateorseveregingivalinflammation,withoutevidenceofperiodontaldisease,andwiththedentist’sabilitytoperformanoralevaluationupfront. D4346’sdescriptorclearlyindicatesthatthiscodeshouldnotbesubmittedwithD1110(prophylaxis,adult),D4341andD4342(scalingandrootplaning),orD4355(fullmouthdebridement)whenperformedonthesameservicedate.Innearlyeverycase,withappropriatetreatmentandimprovedhygiene,moderateorseveregingivalinflammationisareversibleconditionsothesubsequenttreatmentvisit(typicallytwotofourweekslater)couldbedescribedusingtheconventionalprophylaxiscode,D1110.Typically,thepatientisthenplacedonasixmonthrecallschedule. D6081ScalinganddebridementinthepresenceofinflammationormucositisofasingleimplantD6085 Provisional implant crown Usedwhenaperiodofhealingisnecessarypriortofabricationandplacementofpermanentprosthetic. RationaleforaddingD6085:Sometimes,aprovisionalimplantcrownisrequiredfollowingatoothextraction(animmediateimplantandaninterimabutment,D6051,areplaced).Thisprovisionalimplantcrownallowsforahealingperiodfollowingtheextractionsothatthesoft
tissuecanproperlyadapttothenewinterimabutment.Eventhoughtimeforhealingissometimesrequired,therewasnoexistingcodetodescribetheplacementofaprovisionalimplantcrownforahealingperiod.Therefore,D6085wascreatedtoaddressagapintheexistingcodeset. D9311 Consultation with a medical health care professional
-Treating dentist consults with a medical health care professional concerning medical issues that may affect patient’s planned dental treatment.
TheAmericanAcademyofPediatricDentistry(AAPD)submittedarequestfortheadditionofcasemanagementcodestoprovideamethodtoquantifycasemanagementefforts
D9991Dentalcasemanagement–addressingappointmentcompliancebarriers
Individualizedeffortstoassistapatienttomaintainscheduledappointmentsbysolvingtransportationchallengesorotherbarriers.
D9991,addressingappointmentcompliancebarriers.Addressingappointmentcompliancebarriersmayincludetaskssuchasassistingthepatientingettingtoandfromappointmentsontimebyfacilitatingtransportation.
D9992Dentalcasemanagement–carecoordination
Carecoordinationinvolvesworkingwithapatient’sotherhealthcareproviderstoobtaintheoptimalresultfromalltypesofcare.
Assistinginapatient’sdecisionsregardingthecoordinationoforalhealthcareservicesacrossmultipleproviders,providertypes,specialtyareasoftreatment,healthcaresettings,healthcareorganizationsandpaymentsystems.Thisistheadditionaltimeandresourcesexpendedtoprovideexperienceorexpertisebeyondthatpossessedbythepatient.
D9993Dentalcasemanagement–motivationalinterviewing
D9993,motivationalinterviewing.Motivationalinterviewingmeansmotivatingthepatienttoadoptapositiveoralhealthbehaviorormodifyanegativeoralhealthbehaviorusingarecognizedmethod.
Thisisaseparateservicefromtraditionalnutritionalortobaccocounseling.
D9994,patienteducationtoimproveoralhealthliteracy.
Patienteducationoccurswhenthedoctorhelpsthepatientunderstandproperoralhygienethroughanymethod.Thiscouldincludeanarrayofactions,suchasdemonstratinghowtoproperlybrushorfloss,obtaininganinterpretertohelpwithpatientcommunication,orhavingdiscussionswithbothapediatricpatientandacaregivertoprovideoralhygieneinstructions.
Revisitunderusedcodes
Examcodes
D0170 re-evaluation-limited,problemfocused(establishedpatient;notpost-operativevisit)
D0171 re-evaluation-post-operativeofficevisit
D0180 comprehensiveperiodontalevaluation-neworestablishedpatientthisprocedureisindicatedforpatientsshowingsignsorsymptomsofperiodontaldiseaseandforpatientswithriskfactorssuchassmokingordiabetes.
Itincludesevaluationofperiodontalconditions,probingandcharting,evaluationandrecordingofthepatient’sdentalandmedicalhistoryandgeneralhealthassessment.Itmayincludetheevaluationandrecordingofdentalcaries,missingoruneruptedteeth,restorations,occlusalrelationshipsandoralcancerevaluation.
“Thisprocedureisindicatedforpatientsshowingsignsorsymptomsofperiodontaldiseaseandforpatientswithriskfactorssuchassmokingordiabetes.”D9110Palliative(emergency)treatmentofdentalpain–minorprocedure
Thisistypicallyreportedona“pervisit”basisforemergencytreatmentofdentalpain.
Justification(medicalnecessity)forapalliativetreatmentisthatthepatientpresentswithpain,atreatmentisprovided(notjustanevaluationandaprescriptionformedication),andthetreatmentprovidedisminor(notadefinitivetreatment).
D9930 treatmentofcomplications(post-surgical)-unusualcircumstances,byreport
-Forexample,treatmentofadrysocketfollowingextractionorremovalofbonysequestrum.
CleaningandInspectionofremovableappliances
D9931 isnowadeletedcode
D9932 cleaningandinspectionofremovablecompletedenture,maxillary
D9933 cleaningandinspectionofremovablecompletedenture,mandibular
D9934 cleaningandinspectionofremovablepartialdenture,maxillary
D9935 cleaningandinspectionofremovablepartialdenture,mandibular
D1206Topicalapplicationoffluoridevarnish
somethird-partypayerscontinuetomandatetheadultpatienthavemoderatetohighcariesriskforthereimbursementoffluoridevarnish.Thus,acariesriskassessmentshouldbeperformed,documentedintheclinicalchart,andproperlyreportedontheclaimform(typicallyat“zero”fee,asthisisincludedintheglobalfeefortheevaluation).Afindingofmoderateorhighcariesriskcouldincreasethepotentialforreimbursement.
Cariesriskassessments,D0602(moderate)orD0603(severe),shouldbereportedontheclaimtohelpestablishmedicalnecessity.
Anappropriatenarrativemightstate:
“Cariesriskassessmentplacedtheadultpatientathighriskfordentalcaries.”
D1354interimcariesarrestingmedicament
ThenewCDT2016codeD1354,interimcariesarrestingmedicamentapplication,wouldbetheappropriatecodetousewhenreportingtheapplicationofSilverDiaminefluoridetothedentitiontoarrestcaries.
WhileD1354isnota“byreport”code,anarrativemaybehelpfulinobtainingabenefitforthepatient.
ThenarrativeshouldnoteteethXYZhadnon-symptomaticcariouslesions,thenindicatewhytheapplicationofinterimcariesarrestingmedicamentwaschosenratherthanadefinitiverestoration,suchasanamalgamorcompositerestoration.
D1353 sealantrepair-pertoothOneyearafterplacingdentalsealantsontheocclusalsurfacesofthepatient’sfourfirstpermanentmolars.
Sealantmaintenanceandrepairareanessentialpartofaneffectivecaries-controlprotocolforsusceptibleteethandmoderatetohigh-riskpopulations
Crown&Bridgecodes
D2949 restorativefoundationforanindirectrestorationD4212Gingivectomy(toallowforrestorativeaccess),pertoothD4249Clinicalcrownlengthening-hardtissueD2799provisionalcrownistheappropriatecodeusedtoreportaprovisionalcrownplacedtoallowforfurthertreatmentordiagnosis.Vs.theoldcodeD2970,temporarycrown(fracturedtooth),hasbeendeletedfromCDT2016,whatcodeorD6085ProvisionalimplantcrownUsedwhenaperiodofhealingisnecessarypriortofabricationandplacementofpermanentprosthetic.D9120 fixedpartialdenturesectioningEndodonticcodesD3427periradicularsurgerywithoutapicoectomyD3428bonegraftinconjunctionwithperiradicularsurgery-pertooth,singlesite
D3429bonegraftinconjunctionwithperiradicularsurgery-eachadditionalcontiguoustoothinthesamesurgicalsiteD3431biologicmaterialstoaidinsoftandosseoustissueregenerationinconjunctionwithperiradicularsurgeryD3432 guidedtissueregeneration,resorbablebarrier,persite,inconjunctionwithperiradicularsurgeryOverDentureD5867 replacementofreplaceablepartofsemi-precisionorprecisionattachment(maleorfemalecomponent)D5993maintenanceandcleaningofamaxillofacialprosthesis(extraorintraoral)otherthanrequiredadjustments,byreportBoneGraftingD6103bonegraftforrepairofperi-implantdefect-doesnotincludeflapentryandclosureD6104bonegraftattimeofimplantplacementD7953bonereplacementgraftforridgepreservation-persiteOrthodonticRetainersD8692 replacementoflostorbrokenretainerD8693 re-cementorre-bondfixedretainerApplicationofDesensitizingmedicamentsD9910 applicationofdesensitizingmedicamentforrootsensitivity.Includesin-officetreatmentforrootsensitivity.Typicallyreportedona"pervisit"basisforapplicationoftopicalfluoride.Thiscodeisnottobeusedforbases,linersoradhesivesusedunderrestorations.D9911 applicationofdesensitizingresinforcervicaland/orrootsurface,pertooth.Typicallyreportedona"pertooth"basisforapplicationofadhesiveresins.Thiscodeisnottobeusedforbases,liners,oradhesivesusedunderrestorations.AppointmentmanagementcodesD9986missedappointmentD9987 cancelledappointmentKeywordswhenfilingSRPTheSRPkeywordsare:
»»Bleedingonprobing.Bleedingonprobingindicatesactiveperiodontaldisease;healthytissuedoesnotbleedunlesstraumatized.»»Pocketingof4-5mm(orgreater)withattachmentloss.Thesemeasurementsvarywiththecriteriaestablishedbythepatient’sdentalplandocument.(Notethatthisdoesnotincludepseudopockets.Clinicallossofattachmentmustbedocumented.)»»Radiographicevidenceofboneloss.Ifthereisnoboneloss,thereisnoexposedrootforrootplaning.Anexampleofacompleteperiodontaldiagnosisis:"Chronicgeneralizedsevereperiodontitis."TheBuildupkeywordsare:Thisdescriptorclearlyestablishesthatacorebuildupismedicallynecessarywhenthereisinsufficientretentionfortheindirectrestoration.Supportiveradiographicimagesandphotographsofthepreparationalsohelpdocumentthelackofretentionavailablewithoutacorebuildup.First,besuretonotetheamountoftoothremainingafterpreparation.Atleast50percentofthetoothshouldbemissingtoqualifyforreimbursement.Second,ahistoryofendodontictreatmentcanimpactthereimbursementofacorebuildup.Ifthetoothhasreceivedendodontictreatment,besuretodocumentthatfactbysendingaradiographicimageofthetoothshowingthecompletedendodontictherapy.CTSCrackedtoothsyndrome…..Thus,thekeywordassociatedwithacrackedtooththathelpstoestablishmedicalnecessityandgainreimbursementispain.Crackedteethshowavarietyofsymptoms,includingerraticpainwhenchewing,possiblywithreleaseofbitingpressureorwhenthetoothisexposedtoextremetemperatures.Inmanycases,thepainmaycomeandgo,orbeepisodic.Ifthereispainassociatedwiththetooth,notethepainfulsymptomsintheclinicalrecordandontheclaim.Alsoindicateifthepatientpresentedforapreviousappointmenttorelievethepain(e.g.,byadjustingthebite)andthattheattemptwasineffectiveanddidnotalleviatethepain.
