ICD-10 And CDT Dental Codes And Their Eligibility Verification

Dental insurance verification and accuracy in reporting ICD-10 and CDT dental codes on the claims submitted to insurance companies are crucial for timely reimbursement. The ICD-10 diagnosis codes signify particular dental diseases, disorders and symptoms, while the CDT procedural codes are used to report various diagnostic, preventive, restorative, endodontics, periodontics, removable prosthodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, oral and maxillofacial surgery, orthodontics, and adjunctive general services on dental insurance claims.

Dental practitioners help patients suffering from various dental problems and prompt service is essential for excellent patient care. Some of the most common dental problems dentists treat include:

• Erosion of teeth
• Dental caries
• Gingivitis
• Periodontitis
• Endodontic treatment
• Resin restoration

ICD-10 Codes for Common Dental Problems and Related CDT Procedural Codes

Erosion of teeth

ICD-10-CM Code(s)

• K03.2: Erosion of teeth
• K03.3: Pathological resorption of teeth
• K03.7: Post eruptive color changes of dental hard tissues

CDT Code(s)

• D7880: Occlusal orthotic device, by report
• D7881: Occlusal orthotic device adjustment
• D1206: Topical application of fluoride varnish
• D1208: Topical application of fluoride-excluding Varnish
• D1310: Nutritional counselling for control of dental disease

Dental Caries

ICD-10-CM Code(s)

• K02.3: Arrested dental caries
• K02.5: Dental caries on pit and fissure surface
• K02.51: Dental caries on pit and fissure surface limited to enamel
• K02.52: Dental caries on pit and fissure surface penetrating into dentin
• K02.53: Dental caries on pit and fissure surface penetrating into pulp
• K02.63: Dental caries on smooth surface penetrating into pulp
• K02.7: Dental root caries
• K02.9: Unspecified dental caries

CDT Code(s)

• D1330: Oral hygiene instructions
• D0601: Caries risk assessment and documentation, with a finding of low risk
• D0602: Caries risk assessment and documentation, with a finding of moderate risk.
• D0603: Caries risk assessment and documentation, with a finding of high risk

Gingivitis

ICD-10-CM Code(s)

• K05.0: Acute gingivitis
• K05.00: Acute gingivitis, plaque induced
• K05.01: Acute gingivitis, non-plaque induced
• K05.1: Chronic gingivitis
• K05.10: Chronic gingivitis, plaque induced
• K05.11: Chronic gingivitis, on-plaque induced

CDT Code(s)

• D9110: Palliative (emergency) treatment of dental pain-minor procedure.
• D4210: Gingivectomy or gingivoplasty- four or more contiguous teeth or tooth bounded spaces per quadrant.
• D4211: Gingivectomy or Gingivoplasty-one to three contagious teeth or tooth bounded spaces per quadrant.
• D4212: Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth.

Periodontitis

ICD -10- CM code(s)

• K05.2: Aggressive periodontitis
• K04.20: Unspecified aggressive periodontitis
• K05.21: Aggressive periodontitis, localized
• K05.221: Aggressive periodontitis, generalized, slight
• K05.222: Acute periodontitis, generalized, moderate
• K05.223: Aggressive periodontitis, generalized, severe
• K05.3: Chronic periodontitis
• K05.30: Chronic periodontitis, unspecified
• K05.311: Chronic periodontitis, localized, slight
• K05.312: Chronic periodontitis, localized, moderate
• K05.313: Chronic periodontitis, localized, severe
• K05.319: Chronic periodontitis, localized, unspecified severity
• K05.321: Chronic periodontitis, generalized, slight
• K05.322: Chronic periodontitis, generalized, moderate
• K05.323: Chronic periodontitis, generalized, severe
• K05.329: Chronic periodontitis, generalized, unspecified severity
• K05.4: Periodontitis
• K05.5: Other periodontal diseases
• K05.6: Unspecified periodontal disease

CDT Code(s)

• D4341: Periodontal scaling and root planning-four or more teeth per quadrant
• D4342: Periodontal scaling and root planning- one to three teeth per quadrant
• D4910: Periodontal maintenance
• D4381: Localized delivery pf antimicrobial agents via controlled release vehicle into diseased crevicular tissue, per tooth

Endodontics

ICD-10-CM code(s)

• K04.0: Pulpitis
• K04.01: Reversible pulpitis
• K04.02: Irreversible pulpitis

CDT code(s)

• D3110: Pulp cap direct (excluding final restoration)
• D3120: Pulp cap-indirect (excluding final restoration)
• D3220: Therapeutic pulpotomy (excluding final restoration) – removal of pulp coronal to the dentinocemental junction and application of medicament
• D3221: Pulpal debridement, primary and permanent teeth
• D3310: Endodontic therapy, anterior tooth (excluding final restoration)
• D3320: Endodontic therapy, bicuspid tooth (excluding final restoration)
• D3330: Endodontic therapy, molar (excluding final restoration)

Resin Restoration

ICD-10-CM codes

• K03.2: Erosion of teeth
• K03.3: Pathological resorption of teeth
• K03.7: Post eruptive color changes of dental hard tissues
• K02.5: Dental caries on pit and fissure surface
• K02.51: Dental caries on pit and fissure surface limited to enamel
• K02.52: Dental caries on pit and fissure surface penetrating into dentin

CDT-10 codes

• D2650: Inlay-resin-based composite-one surface
• D2651: Inlay-resin-based composite-two surfaces
• D2652: Inlay-resin-based composite-three or more surfaces
• D2662: Onlay-resin based composite-two surfaces
• D2710: Crown-resin-based composite (indirect)
• D2712: Crown – ¾ resin-based composite (indirect)

Insurance Eligibility Verification –an Important First Step

Insurance eligibility verification is a key step to ensure that the dental insurance claims are not denied. So, dental offices must review a patient’s benefits before they enter the office. Eligibility verification involves verifying that the patient’s information is up-to-date, his/her benefits are still active, and what is and is not covered by the insurance. For instance, if a patient is requesting a whitening procedure, you must verify whether their insurance plan will cover such a cosmetic procedure. Also, the rules of their benefits as regards frequency and waiting periods must be verified. Often, patients do not completely understand their own benefits and so the dental practice must know all details regarding the patient’s benefits. Only if the dental insurance verification is accurately done, the dentist will receive the due reimbursement.

A dental billing company can prove to be a valuable partner for busy dentists because they will proactively verify the patient’s insurance eligibility even before the patient’s appointment date. They will obtain prior authorizations for particular dentistry codes such as implants, scaling, root canal treatment, crowns and other procedures that require pre-authorization so that claim denials and delays are avoided. In addition, other details will also be verified such as policy status, plan exclusions, deductibles, claims mailing address, and pre-authorization number among others.

Dental billing companies can be entrusted with error-free dental billing and coding because their billing experts stay updated with the frequently changing dental codes. This ensures that dental practitioners can focus on providing patient care and considerably reduce the overhead expenses they might incur if in-house billing staff is hired.