June 4, 2018

Patient presents for endodontic therapy through an existing crown on #29. Access must be sealed, what code do I submit?

According to past articles in dental journals and some Continuing Education lectures on coding, two obvious choices for this scenario have been routinely proposed.

D2980 Crown repair or D2391 Single surface posterior composite restoration.

One dental publication suggests billing D2980.   I suppose this makes sense if you look at the nomenclature (the written title of the procedure code) which states “Crown repair”.

The other suggestion; billing for a single surface restoration also makes sense  (you are essentially placing an occlusal restoration)  …..so which is correct?

In my opinion - NEITHER….let’s talk about why?

When in doubt, check the descriptor. If you look at the language and description of the procedure, I believe you will see why neither is appropriate.

D2980 – crown repair necessitated by restorative material failure.

D2391 resin-based composite – one surface, posterior….
Used to restore a carious lesion into the dentin or a deeply eroded area into the dentin/ Not a preventative procedure.

Was there material failure? – NO – yes you are repairing a crown, but it’s not due to material failure….that eliminates D2980

Was the reason for the restoration a carious lesion into dentin? NO – Yes, you are placing a composite restoration – but essentially it is not for the purpose of a carious lesion...that eliminates D2391

In my opinion, none of those would be appropriate by definition.  …..

 Unspecified by report codes are used when, in the opinion of the dentist, there is no other CDT Code entry that accurately describes the services provided by the patient.

The most appropriate code would be either D2999 or D3999 accompanied by a written narrative.