2019 New Coding Considerations

By Jim Philhower

The ADAs Code Maintenance Committee (CMC) is responsible for maintaining the Code on Dental Procedures and Terminology (CDT) code set. The Committee meets annually to review that year's submitted change requests and votes to accept, amend, or decline each request based on the best interests of the profession, patients and payers.

Dental practices use CDT Codes to document, report, and bill for dental services they perform. Reporting old or outdated codes can lead to claims being denied or delayed. The 2019 CDT code set became effective January 1st 2019.

This article will review the four deleted codes and a few of the new codes for 2019.

Four Deleted Codes for 2019:

• D9940 Occlusal Guard by report
• D1515 Space Maintainer — fixed — bilateral. Current CDT code is not specific to which arch is involved in the treatment
• D1525 Space Maintainer — removable — bilateral. Current CDT code is not specific to which arch is being treated.
• D5281 Removable unilateral partial denture one-piece cast or metal. The current CDT code is not specific as to the arch involved in treatment.

A few of the New Codes for 2019:

• D9944 Occlusal guard-hard appliance, full arch.
• D9945 Occlusal guard-soft appliance, full arch.
• D9946 Occlusal guard-hard appliance partial arch

Rationale for D9944, D9945, and D9946:

Having a code for each broad type of occlusal guard brings greater specificity to the code and eliminates the need for a "by report" procedure.

• D1516 Space Maintainer — fixed — bilateral Maxillary
• D1517 Space Maintainer — fixed — bilateral Mandibular

Rationale for D1516 and D1517:

• D1516 and D1517 specifically identify the arch treated allowing the claim to be auto-adjudicated. This helps prevent requests for additional information and decreased reimbursement time.
• D1526 Space Maintainer — Removable bilateral-maxillary
• D1527 Space Maintainer — Removable bilateral mandibular

Rationale for D1526 and D1527:

• D1526 and D1527 specifically identify the arch being treated allowing the claim to be auto-adjudicated. This helps prevent requests for additional information and decreased reimbursement time.
• D5282 Removable unilateral partial denture-one piece cast metal maxillary
• D5283 Removable unilateral partial denture one-piece cast metal mandibular

Rationale for D5282 and D5283:

• D5282 and D5283 were created to bring increase granularity within the procedure set. Creating two codes one for each arch also brings the code in-line with the rest of the codes is the partial denture set.
• D0412 Blood glucose level test-in-office using a glucose meter.

This procedure provides an immediate finding of the patients' blood glucose level at the time of sample collection for the point of service analysis.

Rationale for D0412:

Diabetes is one of the most common chronic diseases. Therefore, dentists are likely to encounter patients with the disease. Current blood sugar levels cannot be obtained from an A1c test; you must use a glucometer. The findings must be documented in the patient's record and provided to the patient.

In all the A.D.A. C.M.C. added 15 codes, deleted 4 codes and revised five codes for 2019.

It is essential that dental teams stay up to date on the latest changes and additions made to the CDT code set. Always report the current dental code that most accurately represents the treatment rendered. This will help speed reimbursement and reduce administrative time handling additional requests for information.

To stay current on the CDT codes, contact your Henry Schein representative to order Dr. Charles Blair's Coding with Confidence Book and subscribe to Dr. Blair's Practice Booster on-line coding and insurance resource which includes the bi-monthly Insurance Solutions Newsletter.