Prepare for dental code changes in 2015

Dentists need to ensure that their practices are prepared for dental procedure code changes that go into effect Jan. 1. There are 73 code changes, including 16 new procedure codes.

The ADA released the latest version of the Current Dental Terminology (CDT) Codes earlier this year.

The 16 new procedure codes include the following:
  • Re-evaluation at a postoperative office visit;
  • 3-D photographic image;
  • Sealant repair, per tooth;
  • Cleaning and inspection of removable appliances;
  • Retainers for resin bonded fixed prosthesis;
    Missed and cancelled appointments;
  • Administrative issues; and
  • Evaluation for deep sedation or general anesthesia.
There are 52 code revisions, including these revised procedure codes:
  • Topical application of fluoride;
  • Coping;
  • Inlay/onlay restorations;
  • Clinical crown lengthening,
  • Hard tissue;
  • Osseous surgery;
  • Implant/abutment supported removable dentures;
  • Peri-implant defects;
  • Placement of temporary anchorage devices;
  • Incisional biopsies; and
  • Sedation.

Five codes have been deleted from CDT:

  • D6053 Implant-/abutment-supported removable denture for completely edentulous arch;
  • D6054 Implant-/abutment-supported removable denture for partially edentulous arch;
  • D6078 Implant-/abutment-supported fixed denture for completely edentulous arch;
  • D6079 Implant-/abutment-supported fixed denture for partially edentulous arch; and
  • D6975 Coping.
Please remember that while dental plans are required to recognize current CDT codes, they are not required to pay or provide benefits for new codes as they become effective. Dental offices are encouraged to review dental plans' payment and processing guidelines to determine whether benefits are payable and any documentation requirements.

Copies of the CDT 2015 (both hard copy and e-book) are available for purchase through the American Dental Association's website, ADAcatalog.org.

In 2015, CDA will offer members many dental benefit educational opportunities. Below is a chronological listing of deadlines and dates.

Dental Benefits Workshops - Sacramento (April 16-17, 2015) and Irvine (Oct. 22-23, 2015)

The two-day CDA Dental Benefits Workshops will provide dentists with the skills to improve practice profitability and the confidence to work with dental plans on their terms. Registration and workshop details can be found at cda.org/dbw.

A Guided Tour Through the Dental Benefits Jungle - CDA Presents in Anaheim (May 1, 2015)

This two-and-a-half-hour program will be offered the morning of Friday, May 1, at the Anaheim Convention Center and will walk attendees through a typical day in a dental practice and address some of the common scenarios dentists and office teams face when dealing with patients' dental benefit plans. Attendees will learn proactive tips to assist with navigating the dental benefit coverage jungle and learn about valuable resources to enhance billing efficiency. Resolving plan disputes, coordinating benefits and understanding payment processing are just a few of the topics that will be addressed. This same program will be offered at CDA Presents in San Francisco Aug. 20-22.

Medicare Enroll/Opt-Out Deadline (June 1, 2015)

June 1 is the deadline for dentists to enroll or opt out as Medicare providers. Regardless of which direction a dentist elects to go, this process can take several months, so dentists are encouraged to evaluate practice operations and determine which option is best for their patients and their practice well in advance of the June 1 deadline. More information regarding Medicare enrollment/opt-out can be found via the following websites: cda.org, ada.org and cms.gov.

ICD-10 Code Implementation (Oct. 1, 2015)

Effective Oct. 1, the ninth edition of the International Classification of Diseases (ICD) code sets will be replaced by ICD-10. The ICD-10 includes greater specificity than ICD-9 and more than 70,000 detailed diagnostic codes.

While dentists are not required to submit diagnostic coding for dental claims, dentists who perform oral surgery, treat temporomandibular disorders, facial pain and sleep apnea, treat patients in a hospital or outpatient surgery center and submit claims to medical plans may need to utilize the new ICD-10 diagnostic codes to ensure timely payment for treatment.

More information regarding ICD-10 can be found at cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10.

CDA Practice Support offers hundreds of dental benefit, employment, regulatory compliance and practice management resources to CDA members as a free member benefit. Be sure to visit cda.org to learn more about the various tools available to assist dentists with dental benefit plans.