We are all hoping for an improved climate and maybe a little “normal” in the coming year. In dentistry, 2021 will bring some new dental insurance codes, revise some existing codes, and delete a few from use. We can look forward to changes that will help us more clearly represent the services we provide for our patients and enhance the metrics for tracking those services.
To better understand the annual changes and adoptions, one must give credit to those working on our behalf to represent dentistry in the clinical environment. The Current Dental Terminology, more commonly known as CDT codes, serves dental providers to ensure proper metrics and correct reporting of procedures. The American Dental Association (ADA) is the overseeing agency that consistently looks at trends and needs as they relate to dental procedures. The ADA states that the “purpose of the CDT code is to achieve uniformity, consistency, and specificity in accurately documenting dental treatment. One use of the CDT code is to provide for the efficient processing of dental claims, and another is to populate an Electronic Health Record.”1
In the year 2000, the standardized CDT code set was adopted and must be used for any electronic or paper dental insurance claim forms. This adoption created a uniform reporting and metrics system.
As a part of the ADA, the Council on Dental Benefits Program holds the responsibility for maintaining the CDT codes through an established group called the Code Maintenance Committee (CMC). This committee includes a variety of representatives from the dental specialty groups and third-party payers, and each group’s representative serves as a voting party in the decision-making process. Every spring, the CMC reviews all of the submitted proposals and ultimately votes to add, delete, or amend CDT codes for use the following calendar year.
Notable new CDT codes for 2021
These are some of the most notable CDT code additions that will take effect in January 2021:
- D0604: Antigen testing for a public health-related pathogen, including coronavirus
- D0605: Antibody testing for a public health-related pathogen, including coronavirus
- D1355: Caries preventive medicament—per tooth (this can include silver diamine fluoride application)
- D5995 and D5996: Periodontal medicament carrier with peripheral seal—laboratory processed, maxillary and mandibular respectively
Please note the codes for the periodontal medicament carrier are respective to the arches and were created to replace the deleted D5994 CDT code, which did not specify the arch. In light of the current pandemic, COVID-19 antigen and antibody testing will be allowed by dental professionals in some states depending on the states’ dental practice acts.
New codes for obtaining images
New for 2021 is a series of CDT codes that can be used for radiographic “image capture only.” The suite of new codes should be utilized for the “capture of images for clinical reasons and for diagnostic quality and part of the patient’s clinical record.” However, the capture is by a practitioner “not associated with interpretation and report.” For the mobile or general supervision hygienist, this will allow for reporting and billing of the captured radiographs and sending them for a diagnostic evaluation.
Teledentistry did not begin with COVID-19, but the pandemic was the catalyst for rapid adoption of this technology. Teledentistry has been making its mark on dentistry for years. CDT codes D9995 (synchronous) and D9996 (asynchronous) were adopted as billable CDT procedures in 2017.2 Teledentistry has aided in providing care through mobile hygiene and increasing access to care where a dental hygienist can care for patients under the general supervision of a dentist. Depending on the individual state’s dental practice act, this may apply to a dental hygienist who captures images and then refers to the supervising dentist, or it may include a dental provider who captures images and refers to a specialist for evaluation and care.
Additionally, the new CDT code, D0704: 3-D photographic image—image capture only, can be very useful in teledentistry and dental outreach efforts when we look toward access to care. We now have a metric for reporting capture of intraoral images to provide a comprehensive report or for patient education. Keep a lookout for CDT codes D0701 through D0709 in the 2021 CDT Manual for a full explanation.
Hygienists have a voice
The Dental Coding Consortium (DCC) consists of a group of dental hygienists from all over the United States, banded together by a vision from the founder and dental coding guru Patti DiGangi. All participants have chosen to be involved to make a difference and strive for advancement in the dental profession. The goal of this grassroots group is to review current CDT codes, submit proposals for changes or additions, and provide testimony at the CMC meeting each March. While there is no dental hygiene-specific association with a CMC voting seat, the voice of the hygienist is being heard.
The year-round process brings DCC volunteers together to review trends and needs in dentistry and identify where a need may exist for revisions to the current CDT code manual. For 2021, the DCC brought forward proposals and came away with one big win—the acceptance and creation of a new code to address substance use and abuse in our culture. As dental professionals, we often notice the signs, have difficult discussions with patients about substance abuse, and provide counseling for them. Now there is a code to document this service—D1321: Counseling for the control and prevention of adverse oral, behavioral, and systemic health effects associated with high-risk substance use. This includes ingesting, injecting, inhaling, and vaping.
Substance use counseling is a great service for patients, and providers now have a metric to record the service. The new D1321 code includes (but is not limited to) the following: “Substances used in a high-risk manner may include alcohol, opioids, nicotine, cannabis, methamphetamine, pharmaceuticals, and other chemicals.” Dental professionals often see emergency patients and recognize the ones who are seeking a prescription to fulfill a habit. These are the patients we often worry about. With the increasing use of chemicals and drugs, it is valuable for dental providers to be able to isolate the signs of abuse, counsel appropriately, and make any necessary referrals.
Nonhygiene-specific codes
Twenty-eight new codes have been added to ring in 2021, and many will apply to restorative dentistry and oral surgery. Codes have been adapted to clarify surgical exposure of root surfaces without apicoectomy. The surgical repair of root resorption is now categorized by anterior, premolar, or molar codes and does not include placement of a final restoration. The frenectomy procedure is now coded as site-specific and either buccal/labial or lingual.
For patients who need a crown but who have finances that prohibit a custom crown, a prefabricated porcelain/ceramic crown may be the answer. The new D2928 code has been adopted specifically for that reason and provides accurate reporting of the specified procedure.
The popularity and advancements in implant dentistry have led to the need for new codes to record placement of semiprecision abutments and attachments—codes D6191 and D6192, respectively. Advances in surgical procedures and the ability to place an extraoral craniofacial implant is a procedure many of us will never see, but there is a new CDT code for it beginning this year.
The ADA and the CMC work in conjunction to consistently evaluate the procedure codes we use daily in clinical practice. Did you know that anyone can submit a code proposal for review and adoption to the CMC? If you have a great idea or see a need for a change or addition, make your voice known—or, better yet, band together with like-minded professionals to work together to make a difference in the dental community. As 2021 begins, there will be a new set of codes for dental procedures that can enhance your practice.
References
1. Code on dental procedures and nomenclature (CDT code). American Dental Association. https://www.ada.org/en/publications/cdt
2. D9995 and D9996—ADA guide to understanding and documenting teledentistry events. Version 2. American Dental Association. March 27, 2020. https://www.ada.org/~/media/ADA/Publications/Files/CDT_D9995D9996-GuideTo_v1_2017Jul17.pdf
JAMIE COLLINS, BS, RDH-EA, is a practicing clinical hygienist in Idaho and Washington states. She has been in the dental field for nearly 20 years, both as an assistant and a hygienist. With a passion for patient care, especially for those with higher risk factors, she enjoys sharing the tips and tricks of the dental profession through speaking and writing. In addition to being in clinical practice, she is an educator, has contributed to multiple textbooks and curriculum development, and is a key opinion leader. Contact her at [email protected].
