The most common scenario I hear about is Endo:

• You work really hard on an endo treatment, find multiple canals, or have to complete the therapy in multiple visits instead of one - obviously there are times when it costs us more chair time to provide the same procedure, however, the current codes have no way to reflect that nor do the fees reflect your time and efforts. What do you do?

  CDT codes for reporting and documenting endodontic treatment/therapy procedures by location in the mouth (for example, anterior, premolar or molar tooth) changed way back in 1990.  The change replaced dental procedure codes based on the number of canals per tooth either 2, 3 or 4.  There was even an additional code for “each additional canal” that is used when needed. The reason for the change is to reflect what most often happens in clinical situations.

• What if it takes you two visits to complete endodontic therapy instead of one visit - how do I code for that?

  Well, your first and primary responsibility is to choose a code that most accurately reflects what you did and there is no CDT code to reflect multiple visits or different levels of complexity.  How do you document two separate visits?

  Well, I would suggest that the first visit be documented by the code D3999.  This would be for the initial visit, the diagnosis, and the opening of the tooth to start the endo.  This is obviously reported for record keeping purposes …because reimbursement would be based on the completed treatment.  At the second appointment or last appointment if there are multiple, you would then choose the D3330 code used to reflect the treatment rendered and completion of the treatment.

  The coding conundrum stems from the amount of time and work which went into this procedure that isn’t reflected in the code or the reimbursement fee.

• Every dentist is responsible for determining their fee for a service. This equation should be based on many things that I harp on all the time…but that is a different subject all together. When setting fees, you should really consider these types of “exceptions” to the general rule. I’m not suggesting you gouge patients, but you should consider the range of costs if the procedure isn’t straight forward and make accommodations, so the fee is appropriate. Would it be ethical or legal to have different fees for the same procedures? NO, I don’t think so, but perhaps dentistry could find a way to add a “modifier” to a code, much in the same way medicine has the ability to do so. Maybe the “modifier” could indicate a more complex situation that would warrant a higher fee?

   

• In the “world according to Joan, I would like to see a DX3330 with the “X” indicating extra skill, extra time, extra cost, extra canals. I believe the ADA would respond to that suggestion by suggesting the D3999 code. That does make sense to some extent, unless you participate with an insurance carrier who will likely deny the D3999 and disallow you from charging the patient for the extra time, skill and costs….just saying.

   

• The ADA owns the Dental CDT codes. You all have the ability to propose suggestions for new codes, revisions and deletions. If you are not satisfied or if you feel strongly regarding reporting mechanisms, you should get involved with NJDA’s Council on Dental Benefits and voice your suggestions. You can do this through your component Council representative or in person. The Council can present your suggestions to the ADA’s CDT Coding committee and who knows, you may evoke positive change!