BIG Changes to Coding in 2023 Bring Changes to Treatment Planning
Estela Vargas, CRDH, CEO Remote Sourcing
When we are treatment planning, suddenly, we see new codes available, and a code we are used to is now deleted. How do we begin using the new codes? When a code is added or revised by the ADA, it is usually to fit a need that the ADA CDT Coding Committee has approved. When a code is deleted, it is because it is no longer the standard of care or has been redefined. With coding additions and deletions, we have to rethink our treatment planning.
There are some BIG changes and implications for 2023. The coding committee categorized all of the membrane codes. They made new ones for edentulous areas and implants. These codes are:
D7956 – guided tissue regeneration, edentulous area – resorbable barrier, per site.
D7957 - guided tissue regeneration, edentulous area – non-resorbable barrier, per site
D6106- - guided tissue regeneration – resorbable barrier, per implant.
D6107 - guided tissue regeneration – non-resorbable barrier, per implant.
D4286 Removal of resorbable membrane
For 2023, guided tissue regeneration procedure codes that enable documenting delivery to a natural tooth, an implant, or an edentulous area; whether delivery involves placement of a resorbable or non-resorbable membrane; plus a new code to separately document removal of the non-resorbable membrane.
Learning the CDT coding categories is essential for planning phases in a treatment plan. It is far easier to identify the correct code when you know the types of coding. For example, perio codes are D4, and endodontic codes are D3.
With the first visit, the patient tells their story by describing their perception of what happened to their tooth (teeth) and what caused them to call for an appointment. We begin creating SOAP notes to build a clinical foundation for care. From the solid clinical documentation, the dentist and the clinical team can make a treatment case and have the knowledge to choose the correct corresponding code.
There are changes, additions, revisions, and editorial changes to codes every year. It is crucial to keep up with these changes.
References:
Code Maintenance Committee approves updates in 6 CDT Code categories. https://www.ada.org/publications/ada-news/2022/march/code-maintenance-committee-approves-updates-in-six-cdt-code-categories
BIG Changes in Coding for 2023 Help Treatment Planning
Part 2
Estela Vargas, CRDH, CEO Remote Sourcing
Comprehensive Anterior Implant Coding Scenario.
Treatment Planning for an anterior implant case:
Patient scenario: An adult male patient aged 19 comes in with fractured teeth #7 and #8 from a skateboarding accident. The following coding scenario demonstrates how some of the current and new CDT codes may be used to describe the procedures involved from start to finish of the treatment sequence.
Initial Emergency Visit:
- D0140 – Limited Oral Evaluation-Problem Focused
- D0220 -Intra-Oral-Periapical First Radiographic Image
- D0230- Intra-Oral-Periapical Each Additional Radiographic Image
- Clinical examination reveals the teeth cannot be saved due to horizontal root fractures; CT is indicated to ensure no other pathologies are associated with the trauma or preexisting and to plan for future implants.
- Rx pain medication
- D9110 – Palliative Treatment of Dental Pain-Minor Procedure -
Remove the teeth from occlusion and stabilize them
Pre-Surgical Phase:
- D0367 - cone beam CT capture and interpretation with the field of view of one entire dental arch - maxilla, with or without cranium
- CTs goes out to a radiologist for review and report, CYA!
- D0391 - interpretation of a diagnostic image by a practitioner not associated with the capture of the image, including report
- Impression for an interim partial denture, aka "flipper."
- D0801 - 3D dental surface scan (new code, this is the impression with a wand like iTero, ideal for this situation where alginate impression would not work due to the fractures)
- D9219 evaluation for moderate sedation, profound sedation, or general anesthesia
- D0393 - virtual treatment simulation using 3D image volume or surface scan
- D6190 - radiographic/surgical implant index, by report
- D9450 case presentation, after detailed and extensive treatment planning
Phase 1
- D9222 deep sedation/general anesthesia - first 15 minutes
- D9223 deep sedation/general anesthesia - each subsequent 15-minute increment
- D9612 therapeutic parenteral drug, two or more administrations, different medications
- Examples: Ondansetron, Dexamethasone, Ketorolac
- 2x D7210 - extraction, erupted tooth requiring Removal of bone and sectioning of tooth, including elevation of the mucoperiosteal flap if indicated
- D7953 - bone replacement graft for ridge preservation - per site
- D7956 - guided tissue regeneration, edentulous area - resorbable barrier, per site (new code for 2023)
- D5820 - interim partial denture (including retentive/clasping materials, rests, teeth, maxillary
- D0171 - re-evaluation - post-operative office visit * to remove sutures at a later date
Phase 2
- D9222 deep sedation/general anesthesia - first 15 minutes
- D9223 deep sedation/general anesthesia - each subsequent 15-minute increment
- D9612 therapeutic parenteral drug, two or more administrations, different medications
-
- Examples: Ondansetron, Dexamethasone, Ketorolac
-
- 2 x D6010 - surgical placement of implant body: endosteal implant
- Optional - D6104 - bone graft at implant placement
The buccal plate did not have enough height and thickness to support the implants and achieve optimal esthetic results fully
- D6106 - guided tissue regeneration - resorbable barrier, per implant (new code for 2023)
- Achieve primary closure
- D0171 - re-evaluation - post-operative office visit * to remove sutures at a later date
Phase 3
- 2 x D6011 - surgical access to an implant body (second-stage implant surgery)
- The patient is very concerned with aesthetics. Interim abutment and crown are indicated to develop gingival contours for ideal esthetic results
- 2x D6051 interim implant abutment placement
- 2x D6085 interim implant crown
Phase 4
- D6198 remove interim implant component
- 2 x D6057 custom fabricated abutment, including placement
- 2x D6058 abutment supported porcelain/ceramic crown
A detailed, comprehensive treatment plan is a guide to the treatment phases. As the stages are delivered, use the plan as a checklist or plan of action to share with the patient.
References:
General Anesthesia and Conscious Sedation Services. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/dental/general-anesthesia-conscious-sedation-svcs.pdf
