Carol Tekavec, RDH
The ADA CDT-4 Codes went into effect on January 1 of this year. Following publication of the current version of the Code, the Code Revision Committee holds a series of meetings to address comments and concerns of the dental community prior to the next Code revision. Out of these meetings come some code clarifications, as well as discussion of new codes suggested by the members of the profession and others for inclusion in the next update.
Adult-Prophylaxis
In February, an important clarification was made concerning the code for an Adult-Prophylaxis, D1110. The current description for this code is: "A dental prophylaxis performed on transitional or permanent dentition that includes scaling and/or polishing procedures to remove coronal plaque, calculus, and stains." The committee made a "clarification to the original intent" of D1110 and stated that the word "or" should be removed from the definition, changing the wording to "scaling and polishing". This clarification is expected to appear in the next printed version of the Code, but should be considered in effect now. Even though that is not what the current code description states, the general opinion is that D1110 should apply to all adult cases not involving periodontal disease — with or without gingivitis — and including both subgingival and supragingival calculus removal.
Topical fluoride description
Another clarification involves the description for topical fluorides.The CDT-4 states, "Application does not include fluoride rinses or 'swish.' " While this seems to clearly indicate that in-office fluoride rinses are not to be considered appropriate for a topical-fluoride application, further inquiry shows that this is not the case. In fact, the Dental Codes Standards and Administration Committee of the Council on Dental Benefit Programs considers in-office fluoride treatments to be those utilizing "materials which require professional administration and supervision." The words "rinse or swish" were added to the CDT-4 to reinforce the position that over-the-counter fluoride materials are not considered appropriate for in-office treatment. Also, the use of materials bearing the ADA Seal or materials that must be applied using oral trays are not required by the Code. By design, the Code is described by the Dental Codes Standards and Administration as not including such limitations. (However, as always, limitations on services may be placed by patient insurance contracts.)
Soft-tissue biopsy
A coding situation needing further clarification involves coding for the Oral CDX Brush Biopsy Kit. There are two CDT-4 codes that describe the removal of soft tissue to provide a sample for a biopsy.
1. D7286-Biopsy of Oral Tissue-Soft — "For surgical removal of specimen only. This code is not used at the same time as codes for apicoectomy/periradicular curettage."
2. D7287-Cytology Sample Collection — "For collection of oral cytology sample via mild scraping of the oral mucosa."
According to Oral Scan laboratories, the developer of the Oral CDX test, the brush biopsy technique obtains a "complete transepithelial tissue sample," not a "superficial exfoliative" sample. Therefore, their position is that D7286 more closely describes the procedure than D7287. The current interpretation of the Dental Codes Standards and Administration is that the CDX brush technique should be reported using D7286 or D7287, based on the depth of the sample taken.
Further clarification for these codes may be expected in the next code revision. Also keep in mind that many dental insurance carriers do not provide a benefit for D7287 and associated oral pathology lab fees. However, a good number of them may provide a benefit for D7286. Medical benefits also frequently apply for surgical biopsy and lab work.
How to suggest changes
Dentists interested in requesting an addition, revision, or deletion to the Code may do so on the ADA Web site at www.ada.org/goto/dentalcode.
Carol Tekavec, RDH, is the author of the Dental Insurance Coding Handbook Update CDT-4, co-designer of a dental chart and an informed consent booklet, and a national lecturer. Contact her at (800) 548-2164 or visit her Web site at www.steppingstonestosuccess.com.
