Dental Procedure Coding Update: What Your Practice Should Know for 2022

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The CDT (Code on Dental Procedures and Nomenclature) codes are changing again this year. Do you know which ones? We take a closer look at the new dental procedure codes for this year and why you need to understand what they are. We also discuss the resources available to you for help with the changes.

Per Outsource Strategies International, a medical billing and coding company, the American Dental Association (ADA) Code Maintenance Committee (CMC) approved 16 additions, 14 revisions, and 6 deletions in March 2021, effective January 1, 2022. They also included 8 codes adopted in March for vaccine administration and molecular testing for public health–related pathogens.[1] There is also a new section on ICD-10 (International Classification of Diseases Tenth Revision) for diagnosis codes. Diagnosis codes are necessary for some dental claims, and all medical benefit claims ICD codes, unlike the CDT codes, are maintained by the federal government.[2]

The changes and revisions touched on several areas. The new procedure codes included those for previsit patient screenings, 3 codes related to sleep apnea appliances, intra- and extracoronal splints, immediate partial dentures, rebasing hybrid prostheses, and removal of temporary anchorage devices. The CMC also approved changes requested by the American Association of Orthodontists to delete the 2 codes for interceptive orthodontic treatment and replace them with 3 codes for limited orthodontic treatment. In addition, the committee approved the 8 codes relating to COVID-19 regarding vaccine administration and antigen and antibody testing.1

Some Notable CDT Changes in 2022

Author and speaker Kathy Forbes, RDH, BS, who is also president of Professional Dental Seminars, says there are a few changes for 2022 that practices should know. For example, there is now a procedure code for patient screenings for COVID-19. The code denotes that you performed a previsit screening and took the patient’s temperature. This procedure code is not for reimbursement so much as it is for risk management, she notes.

“Now that we have a procedure code, you should document it,” Forbes says. “Then, if the patient says they were never screened for COVID-19, you have the documentation that says you did.”

Also, it is critical to remember that just because there is a procedure code for something, it doesn’t mean a payer will reimburse you. For example, Forbes doesn’t think most dental plans will cover the 3 additional codes for fabricating, adjusting, and repairing sleep apnea appliances. However, the patient’s medical insurance might.

“That why I suggest medical insurance pay for it, and it may be paid at 100%,” Forbes says.

As an advisor to the DentalCodeology Consortium reviewing and developing procedure codes, Forbes is a licensed speaker and educator about dental coding. She is working to help dental offices learn how to bill medical insurance. Many dental practices are resistant to taking on the learning curve with such billing, but Forbes thinks they should start from a revenue standpoint.

“If you get 100% of the fee that could be double what you are charging now, why wouldn’t you want to learn it?” she asks.

Seth A. Gibree, DMD, FAGD, senior director of clinical advocacy at Heartland Dental, represents clinicians and team members in his role and finds ways to support them. In his review of the CDT changes for 2022, Gibree noticed an interesting shift in periodic evaluations for 2022. The code says the findings are discussed with the patient. Although he thinks having a discussion with the patient is common sense, Gibree says the committee added the sentence for a reason, which he explains is usually to clear up misinterpretations or establish standards.

CDT code additions also define the dentist’s role in new areas of treatment. For example, Gibree says that having the new, updated codes related to sleep apnea appliances helps define the dentist’s role in treating sleep apnea. Before, dental professionals recorded these procedures with sleep appliances under a catch-all code for “unspecified facial prosthesis.”

“Having those new codes updated shows where a dental provider is important in that discussion with patients that have sleep apnea, can’t wear a CPAP [continuous positive airway pressure machine], and need a sleep appliance that a dentist can deliver for them. Or they’re getting a sleep appliance from a lab but they’re still following up with their dentist or bringing it in. It also helps the practice to be able to document oral conditions related to their patient’s oral sleep appliance,” Gibree says.

Gibree says replacing the codes for “intercepted ortho” gives clinicians more clinical autonomy regarding the orthodontic codes. For example, the expander treatments for a crossbite, the use of a space maintainer, or correcting skeletal or jaw problems are now all under “limited orthodontic treatment.” However, although the new codes open up the orthodontic treatment options to the clinician’s definition, Gibree says the flip side is that dental practices need to be concrete in their payer communication.

“You are not going to be able to file this code as ‘limited ortho treatment – $3,000.’ Instead, you will need to show what you did and write a narrative that says, ‘This is what we were looking at, this is what our goals were, and this is what we are trying to accomplish,’” he explains.

According to Gibree, the new orthodontic codes also open up the possibility to respond to patient desires to fix a slight problem with their smile rather than resolve the comprehensive issues with their bite.

“If a patient doesn’t want comprehensive care, but they want to fix this problem, that is, by definition, limited ortho treatment,” he notes.

The Importance of Staying Current on Dental Codes

There are many reasons to stay current on dental codes. According to Forbes, the most important is to bill appropriately. She says that too often, dental offices don’t realize the dental practice management software only gives them the title and the code number. If the definition changes, that won’t be indicated. If the dental professional doesn’t follow the new definition but bills for it anyway, dental practices could be billing fraudulently without knowing it.

For example, under Comprehensive Evaluations a couple of years ago, an oral cancer evaluation was optional; it said, ‘may perform an oral cancer evaluation.’ However, Forbes says that the definition has changed, and to bill for a comprehensive evaluation you now have to do an oral cancer evaluation, meaning it is no longer optional. Moreover, Forbes explains, if the patient develops a cancerous lesion and you didn’t test for it but billed for a Comprehensive Evaluation, there could be legal ramifications.

“So, it’s important to know the specifics,” Forbes says.

The CDT manual includes the information that is often left out of practice management updates. In particular, the manual contains the procedural code nomenclature and descriptor changes, as well as those for every CDT entry.1

In addition, new codes come along that dental practices can start to bill and be reimbursed for. Forbes notes that if you don’t know what those are, a dental practice might give that revenue away.

The ADA also recommends knowing the codes in its Dental Benefit Video Series, a series of 10- to 20-minute tutorials designed to help dental practices understand how to work with third-party programs produced by the ADA Center for Dental Benefits, Coding and Quality. The “Getting Paid Series” recommends the following best practices3:

Understand the processing policies

Be ready to explain the options to the patient before treatment has begun

Ensure that the treatment plan is not limited by the payer policies

Code for What You Do

Appeal medical necessity denials

Gibree echoes the ADA’s sentiment. He says that knowing the codes is essential to document accurately and bill for what dentists need to bill. Moreover, knowing the codes streamlines the process, because improper codes disrupt reimbursement, and communicates to the payer what you are doing, he explains.

“It’s another validation point that what you do in a patient’s mouth, what they agree upon from their treatment plan, matches what’s in their mouth and also what’s in the records and what you are billing,” Gibree says.

Some of the language in the code is there to protect the patient too, he points out. It ensures that dental professionals do certain things regarding treatment. Like Forbes, Gibree says that if the committee defines a code as something specific, dental professionals should be following it.

“An insertion or deletion of a word can completely change the way the code is utilized,” he notes. “For instance, if there is a surgical extraction that needs to have a bone removed by a surgical drill and a surgical drill removes no bone, then by nature of the definition it is not a surgical extraction. It should be billed as something else.”

An example from this year’s changes in definition is the code related to caries arresting medicament (code 1350). This year the code no longer has the word “interim” and now says “application of arresting medicament per tooth.” Another example occurs in a code about temporary crowns; in the definition the committee changed the word “provisional” to “interim.”

“A lot of times, those single-word changes are to clarify things that could be misconstrued or miscommunicated in the code,” Gibree says.

When he reviewed the changes for 2022, the partial denture changes stood out to him because of the implications he sees coming as 3D printing of partial dentures becomes more mainstream. The codes will need to reflect that. Moreover, there were changes about which code to use depending on the type of relining clinicians do for a denture.

“Also, if you do a soft reline and don’t know there is a new soft reline code, issues might come up regarding getting paid,” Gibree says.

Resources for Dental Practices

Many resources can help dental practices stay on top of coding changes. For example, the ADA’s updated Coding Companion comes out every October for the following calendar year. Forbes says it has all sorts of scenarios about which code to use when different situations occur.

“It’s a great educational tool,” he notes.

In addition, the ADA has coding education materials, which have many coding resources available to dental practices at no cost. Videos, webinars, and documents cover topics such as understanding and documenting teledentistry events, overdenture coding guidance, COVID-19 vaccination procedures, and coding for prevention. Also, members can call the ADA’s Member Service Center with questions at (312)440-2500 or email them at dentalcode@ada.org.2

Forbes also likes Charles Blair and colleagues’ book Coding with Confidence, which publishes annually, in addition to Blair’s online suite from PracticeBooster.com. As a contributor to his Insurance Solutions Newsletter, she recommends both useful resources. In addition, she suggests speaking with coding experts Theresa Duncan with Odyssey Management and Christine Taxin with Links2success.

Although many practice management software systems update the codes automatically, Gibree says it is essential to read through the CDT book language to understand what those changes are. Sometimes they get specific in a way that is different than how it was before. However, Gibree suggests it is imperative that the team become familiar with it too. Dentists should be aware of the changes but the dental team should also have a comprehensive understanding of them. That means the team needs the resources and training to understand what changes have been made and how they apply to their office.

“Heartland helps support the offices so they can share information about current changes,” Gibree says. “This would be one of the things I think of as an administrative burden. First, you have to understand what the code says and how it applies to day-to-day activities. Then you have to train your team members [in] how it’s going to be applied so that it can be billed correctly.”

Although CDT code changes fall into the administrative realm of dental practice management, they also reflect the dynamic nature of the dental field and the changing relationship it has to related sciences such as medical. According to Gibree, what you see in the codes shows how the industry has changed over the years.

“The treatment of medicine and dental care is changing as the science grows and we make advancements in technology,” Gibree says. “The CDT will adapt with it so that there is clarifying language in here to help support the way dentistry is going.”

References

1. Darst A. New CDT coding changes for 2022. Outsource Strategies International. Accessed December 1, 2021. https://www.outsourcestrategies.com/blog/new-cdt-coding-changes-for-2022.html
2. FAQ regarding dental codes. American Dental Association. Accessed December 1, 2021. https://www.ada.org/resources/practice/dental-insurance/frequently-asked-questions-regarding-dental-codes
3. Dental Benefit Video Series. American Dental Association. Published 2021. Accessed December 1, 2021. https://www.ada.org/resources/practice/dental-insurance/dental-benefit-videos.