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The American Association of Orthodontists (AAO) has designated October as National Orthodontic Health Month. This month is dedicated to raising awareness about the benefits of orthodontic treatment and the importance of good oral health. Orthodontics aims at improving the appearance of the teeth, making it easier to clean the teeth and how they work by straightening or moving teeth to improve their appearance. This form of dentistry is ideal to straighten crooked teeth, close wide gaps between the teeth, improve speech or chewing ability, boost the long-term health of gums and teeth, and treat an improper bite. It mainly treats malocclusion and helps to correctly position the teeth when the mouth is closed. Left untreated, such issues can result in more serious oral health problems such as tooth decay, tooth loss, gum disease or even jaw problems.

People consider these treatments for cosmetic purposes as well as to improve oral functions. AAO has reported that more than 1.6 million adults in North America are receiving orthodontic treatment from AAO orthodontists. Medical dental devices used for this treatment include headgear, plates, braces, fixed or removable space maintainers, aligners, palatal expanders, retainers, splints and more. To assess the state of the person’s teeth, the orthodontist may carry out a clinical examination, take x-rays of the teeth and jaw and make plaster models of the teeth.

While a dentist specializes in the broader area of oral health, an orthodontist deals specifically with the bite and straightness of teeth. Experienced dental billing companies can provide the challenging medical coding task, as they are up to date with the changing coding standards and insurance guidelines. It is important to include the correct CDT, ICD, HCPCS and CPT codes on the medical claims, as any coding errors could lead to claim denials. For most insurers severe malocclusion requires prior authorization, while cleft palate requires expedited authorization (EPA).

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Some of the ICD-10 and CDT codes related to orthodontic treatments are –

CDT

  • D8010 Limited orthodontic treatment of the primary dentition
  • D8020 Limited orthodontic treatment of the transitional dentition
  • D8030 Limited orthodontic treatment of the adolescent dentition
  • D8040 Limited orthodontic treatment of the adult dentition
  • D8050 Interceptive Orthodontic treatment of the Primary Dentition
  • D8060 Interceptive Orthodontic treatment of the Transitional Dentition
  • D8070-Comprehensive orthodontic treatment of the transitional dentition
  • D8090-Comprehensive orthodontic treatment of the adult dentition
  • D8210 Removable appliance therapy
  • D8220 Fixed appliance therapy
  • D8660 Pre-orthodontic treatment visit
  • D8670 Periodic orthodontic treatment visit (as part of contract)
  • D8680 Orthodontic retention (removal of appliances, construction and placement of retainer(s))
  • D8690 Orthodontic treatment

ICD-10

  • K00.0 Anodontia (missing teeth)
  • K00.1 Hyperdontia (supernumerary teeth)
  • K00.2 Abnormalities of size and form
  • K00.3 Mottled teeth
  • K00.4 Disturbances of tooth formation
  • K00.5 Hereditary disturbances in tooth structure, not elsewhere classified
  • K00.6 Disturbance of tooth eruption
  • K00.8 Other specified disorder of tooth development and eruption
  • K00.9 Unspecified disorder of tooth development and eruption
  • K05.20 Aggressive gingivitis, plaque induced
  • K05.21 Aggressive gingivitis, non-plaque induced
  • K05.22 Aggressive gingivitis, generalized
  • K05.30 Chronic periodontitis, unspecified
  • K05.31 Chronic periodontitis, localized
  • K05.32 Chronic periodontitis, generalized

Completing a full dental eligibility verification before the patient’s date of service is a crucial process. Before providing treatment, practices must ensure that the patient is eligible for orthodontic benefits. Some dental plans restrict benefits to children, but others provide benefits to adults. Other important steps in orthodontic billing include coordination of benefits (COB) and completion of the insurance form.