Coding

CDT Procedure Codes Related to Dental Hygiene Procedures

Reviewed By: Kathy Forbes, RDH, BS

Date: April 28, 2019

This is a sampling of the CDT Procedure Codes related to dental hygiene procedures.  This summary does not contain all procedure codes listed in CDT 2018 (pp. 5-92) but addresses some of the more common ones completed by dental hygienists.  See CDT 2018 for complete descriptors and see the CDT Companion Guide for more details.  Additional resources are included with Kathy’s commentary.  

*Signifies a New or updated code (may include link to ADA’s information)

 

Kathy Forbes has a license with the ADA to provide Education about Dental Procedure Codes. 

Diagnostic: pp. 5-13

D0120 Periodic oral evaluation-established patient
Includes oral cancer evaluation and periodontal screening (AAP defines as measuring 6 points per tooth)
D0140 Limited oral evaluation-problem focused
Related to one specific problem and/or dental emergency
D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver
Performed for children within the first 6 months of eruption of the first primary tooth.  Review medical history and oral health history, evaluate caries risk, develop oral health plan with primary caregiver.
D0150 Comprehensive oral evaluation-new or established patient
New patients or existing patient with significant change in medical or oral health.  Descriptor lists specific procedures to be completed.
D0170 Re-evaluation-limited, problem focused (established patient; not post-operative visit)
Related to a previously existing condition
D0180 Comprehensive periodontal evaluation-new or established patient
For patients with signs, symptoms or risk factors of periodontal disease.  Descriptor lists specific procedures to be completed.

American Academy of Periodontology Checklist for a Comprehensive Periodontal Evaluation:

1.     Teeth, Dental Implants and Subgingival Area

  • Pocket Depth
  • Width of keratinized tissue
  • Gingival recession
  • Attachment level
  • Bleeding on Probing
  • Furcation Status
  • Presence of inflammation

2.     Plaque/Biofilm/Calculus

  • Presence, degree and/or distribution of plaque/biofilm
  • Presence, degree, and /or distribution of calculus

3.     Dentition

  • Caries
  • Proximal Contact relationships
  • Endodontic/periodontal lesions
  • Status of dental restorations and prosthetic appliances
  • Other tooth or implant related problem

4.     Occlusion

  • Degree of mobility of teeth and dental implants
  • Occlusal patterns
  • Fremitus

5.     Diagnostic quality radiographs

  • Quantity/quality of bone
  • Bone loss patterns

6.     Discussion of patient risk factors

  • Age
  • Diabetes
  • Smoking
  • Cardiovascular Disease
  • Other

Acteon’s Soprocare® Diagnostic Camera; highlights plaque/calculus and inflammation/decay, take photos in these various modes.

Invisalign’s® iTero® Scanner; take scans on different dates and it will superimpose the images to highlight tooth wear, movement and recession.

Pre-diagnostic Services, pp. 7

D0190 Screening of a patient
Includes state or federal screenings to determine if referral to a dentist is needed
D0191 Assessment of a patient
Limited inspection to identify signs of disease, injury to determine if referral to a dentist is needed

Diagnostic Imaging: pp.  7-8
includes image capture and interpretation

D0210 Intraoral-complete series of radiographic images
14-22 PA’s/BWs – Frequency determined by Dentist/Hygienist using ADA/CDC recommendations on (See “x-rays” page)
D0220 Intraoral-periapical first radiographic image
D0230 Intraoral-periapical each additional radiographic image
D0270 Bitewing-single radiographic image
D0272 Bitewings-two radiographic images
D0273 Bitewings-three radiographic images
D0274 Bitewings-four radiographic images
D0277 Vertical bitewings – 7 to 8 radiographic images
Does NOT constitute complete intraoral series (FMX)
D0330 Panoramic radiographic image

Test and Examination: pp. 10-11

 

D0411 HbA1c in-office point of service testing
Used when drawing a blood sample and performing analysis
View ADA Guide PDF
*D0412 Blood glucose level test
in-office using a glucose meter
D0417 Collection and preparation of saliva sample for laboratory diagnostic testing.
Ex. OralDNA®, OraVital®
D0422 Collection and preparation of genetic sample material for laboratory analysis and report.
Ex. OralDNA® Pt may need to sign a consent form
D0425 Caries Susceptibility test
Ex. CariScreen® See “Cavities” Page for more test options
D0431 Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities include premalignant and malignant lesions, not to include cytology or biopsy procedures
Ex. ViziLite®   Plus
D0470 Diagnostic casts
Study models
D0601 Caries risk assessment and documentation, with a finding of low risk
Must document and use recognized assessment tool; ADA provides downloads forms for patients over the age of 6 and under the age of 6

ADA Guide (Over 6) and ADA Guide (Age 0-6)

D0602 Caries risk assessment and documentation, with a finding of moderate risk
See D0601
D0603 Caries risk assessment and documentation, with a finding of high risk
See D0601

Prevention: pp. 15-17

D1110 Prophylaxis-Adult
Permanent and transitional dentition; remove plaque, calculus, stains
D1120 Prophylaxis-Child
Primary and transitional dentition; remove plaque, calculus, stains
D1206 Topical application of fluoride varnish
Any age
D1208 Topical application of fluoride – excluding varnish
Any age
D1310 Nutritional counseling for control of dental disease
To address caries and periodontal disease
D1320 Tobacco counseling for the control and prevention of oral disease
To prevent tobacco-related oral conditions
D1330 Oral Hygiene Instruction
Any home care instruction
D1351 Sealant – per tooth
D1353 Sealant repair-per tooth
D1352 Preventive resin restoration in a moderate to high caries risk patient-permanent tooth
Does NOT extend into dentin; be sure to have caries risk tool completed documenting moderate to high caries risk (see D0602/D0603
D1354 Interim caries arresting medicament application
No removal of sound tooth structure; Examples include Phocal™ and Silver Diamine Fluoride.

Non-surgical Periodontal Service pp. 38-40

D4341 Periodontal scaling and root planing-four or more teeth per quadrant
D4342 Periodontal scaling and root planing-one to three teeth per quadrant
D4346 Scaling in presence of generalized moderate or severe gingival inflammation-full mouth, after oral evaluation
Moderate to severe gingival inflammation in 30% or more of the mouth. No Bone Loss! (recession, clinical attachment loss)
D4355 Full mouth debridement to enable comprehensive evaluation and diagnosis
Not to be completed on the same day as any evaluation; preliminary removal of supra-gingival plaque/calculus; intended to be followed with other definite treatment
D4381 Localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth.
FDA approved medication
D4910 Periodontal maintenance
After SRP, for the life of the teeth or implant, varying intervals, includes site specific SRP as necessary.
D4921 Gingival irrigation – per quadrant
Subgingival irrigation with medicinal agent.

Carriers, pp. 56

D5986 Fluoride gel carrier
Prosthesis covering the teeth in order to deliver fluoride close to teeth for several minutes per day
D5994 Periodontal medicament carrier with peripheral seal-laboratory processed
Ex. PerioProtect™

Implant Services, p.63

D6080 Implant maintenance procedure when prostheses are removed and reinserted, including cleansing of prostheses and abutments
For implant supported fixed prostheses.  Debride implant(s) and examine; Patient receives oral hygiene instruction; can be performed with D1110 and D4910
D6081 Scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surfaces, without flap entry and closure
Cannot be used in conjunction with D1110, D4910 or D4346.  Best subgingival biofilm disruption is completed with subgingival polisher (see “Implant” page for more details”)

Anesthesia, pp. 87

D9210 Local anesthesia not in conjunction with operative or surgical procedures
Ex. Oraqix®; Kovanaze®
D9230 Inhalation of nitrous oxide/analgesia, anxiolysis
Use of nitrous oxide/analgesia

Professional Consultation, pp.89

D9311 Consultation with a medical health care professional
When medical professional is consulted about medical issues which could affect patient’s dental treatment
D9430 Office visit for observation (during regularly scheduled hours)-no other services performed
 

Drugs, pp.90

D9630 Drugs or medicaments dispensed in the office for home use
Topical fluoride, oral antibiotics, oral analgesics, etc.

Miscellaneous Services, pp. 90-91

D9910 Application of desensitizing medicament
Per visit for topical fluoride such as varnish
D9911 Application of desensitizing resin for cervical and/or root surface, per tooth
Per tooth; Ex. Gluma®
D9932 Cleaning and inspection of removable complete denture, maxillary
D9933 Cleaning and inspection of removable complete denture, mandibular
D9934 Cleaning and inspection of removable partial denture,

maxillary

D9935 Cleaning and inspection of removable partial denture, mandibular
*D9961 Duplicate/copy patient’s records
D9972 External bleaching-per arch-performed in office
Per arch
D9975 External bleaching for home application, per arch; includes materials and fabrication of custom trays.
*D9990 Certified translation or sign language services, per visit
 D9995 Teledentistry – synchronous; real time encounter
 D9996 Teledentistry – asychronous; information stored and forwarded to dentist for subsequent review
 Mouthwatch are pioneers in the area of teledentistry. They have developed an inexpensive intraoral camera that has received good reviews from dental providers.

FREQUENTLY ASKED QUESTIONS:

Perio maintenance… For life or until stability is achieved? According to the description, D4910 is for the life of the dentition. Frequency can be adjusted as needed. The benefit of using the D4910 is that it includes localized SRP as needed. Remember, it is the health of the gingiva that dictates the code. Encourage your patient to look over his/her insurance policy and choose one with good Periodontal coverage (if they are determined to stick with “what the insurance covers.”)

Do I really need to submit codes that we do not charge for (i.e. Caries risk assessment with a low risk finding)? Yes. These codes are tracked and used in the creation or editing of future codes. Also, consider a time in the future when medical and dental billing is combined and a medical provider only sees the dental codes. Those codes should convey not only what was completed, but how the patient was educated and the health of the patient. A D1110, D0602, D1330, D1206 conveys a lot of information.

Can we bill Medical Insurance? Yes, maybe. When a patient who has CVD or Diabetes Type 2 also presents with Periodontal Disease, it may be possible to have Perio therapy covered by medical insurance. You may need a referral from the MD and you will need to know how to bill medical insurance.

What if my state practice act allows a Dental Hygienist to perform a particular procedure that is not permitted in the Dental Procedure Code? For example, some states allow RDH’s to perform specific evaluations, while the Dental Procedure Codes specify the evaluation is performed by a Dentist. As more states allow RDH’s to work more fully to the extent of his/her education, more Hygienists’ find themselves unsure how to appropriately use the procedure codes. In years past, the ADHA has proposed removing specific providers from procedure codes (specifically evaluation codes); however, this is always rejected by the committee. In 2019 Ms Forbes asked the committee how Dental Hygienist’s proceed when the state law and the procedure code are in conflict. The answer: STATE LAW TRUMPS PROCEDURE CODES! So, if you are in a state that grants authority to complete an evaluation (say D0120), you can submit that procedure code, even though it specifies it is completed by a DDS.

How are Codes Developed?

Every March, a committee gathers to discuss and vote on codes. This committee is composted of Dentists, Dental Hygienists, Insurance Representative and others. These individuals discuss and vote on changes that have been proposed. The following October, the new CDT book is published with all of the changes. The changes take effect the following January. The most recent meeting was March 14-15, 2019, in Chicago (at the ADA Headquarters).

Who are the Hygienists’ that are involved?

Dental Hygienists’ from across the country are part of a focus group. They dialogue throughout the year, research and write the changes or new codes they are recommending. There is a particular form to fill out that includes justification for any proposed change.