Know More about Dental Coding Using CDT, CPT and ICD-10 Codes

Hey, this is Amber Darst, Dental Insurance Coordinator for Managed Outsource Solutions. I am going to be getting down to the basics today talking about coding for dental practices.

Successful dental billing depends a great extent on having a proper understanding of the various code sets – CDT, CPT and ICD 10 codes and when to use them. Each code set has a different purpose and each payer has their own rules for claim submission using these codes.

So let’s start off with the CDT Codes

The CDT code set maintained by the ADA consists of procedural codes for oral health and adjunctive services provided in dentistry. Each alphanumeric CDT code begins with the letter ‘D’ and is followed by 4 numbers. CDT codes are used by dentists to report dental procedures in claims to insurance companies. CDT codes also help dentists to achieve uniformity, consistency and documenting dental treatment accurately in the electronic health record. These codes are updated and revised annually. So definitely watch out for the changes as they do happen each year.

The CDT Code set categorizes codes by type of service. There is: diagnostic, preventative, restorative, endo, perio, implant services, surgery etc. However, nothing in the CDT supports or indicates limitation of use by dentists — general dentists or specialists — to any categorical section(s) of the CDT Code.

And that brings us onto ICD-10 Codes and these are diagnostic codes. They are used to group and identify diseases, disorders and symptoms. Each diagnosis code is a unique, alphanumeric string of characters representing a disorder or disease concept. Diagnostic coding involves transforming verbal descriptors of diseases, illnesses and injuries into standardized codes in claims for services.  And these codes are typically used more in a specialist’s office vs. a general dentist.

So let’s see about the code use in dental practices – some key considerations

• Using CDT codes when billing dental services: All claims submitted on an ADA regulated dental claim form must use dental procedure codes from the CDT code version that was in effect on the date of service. Both in-network and out-of-network providers should use the CDT codes for billing dental services on claims to third-party payers.
• Also consider the type of coverage, well this be dental or medical: A major factor governing CDT vs. CPT code use is the type of coverage that the patient has. To assign a CDT dental code on the claim for a dental procedure, the patient must have dental insurance. However, based on the patient’s insurance policy coverage, medical insurance can be billed if the patient received dental care that was related to a medical condition. As medical plans do not pay for treatment claimed as CDT procedures, dentists need to report the correct CPT codes to describe the medical treatment when submitting claims to the medical plans. Examples of dental procedures that can be billed to medical insurances include:
  • All oral and dental procedures associated with any kind of traumatic injury to the mouth
  • Exams and consultations when oral cancer screening is done, and in preparation for any other medically billable procedure
  • Emergency treatment of oral inflammation and oral infections
  • Diagnostic, radiographic, and surgical or healing stents
  • Radiographs for certain screening and diagnostic purposes
  • Biopsies and excisions, including smears and brush biopsies
  • Surgery that has associated with interim and final prostheses necessitated by a traumatic injury or any medical condition

However, to bill medical insurance, the dental code intended to be used should also have that compatible medical code. So with the ICD-T or the ICD-10 codes this is where these would come in and they can be used along with CDT codes on claims, most generally used for CPT codes though. But they are required on claims for dental services submitted to medical benefit plans.  ICD-10 codes in claims filed for dental benefits inform the payer why the procedure was performed and the associated disease, illness, symptom or disorder. The ICD-10 code categories K00 to K95 which describe diseases of the digestive system include diseases of the mouth and conditions treated by dentists. The appropriate diagnosis code should be selected based on the patient’s present condition.

And that is all, I hope this helps. Please remember that every payer has their own rules regarding coverage of dental expenses. Using the correct codes and ensuring proper clinical documentation is essential for timely and appropriate reimbursement as well as to avoid charges of fraud or violations of state or federal law, including noncompliance.

Thanks for listening in!