Insurance Coding Changes for 2013

By Dr. Charles Blair

Current Dental Terminology (CDT) 2013 has now been released. The combined efforts of the prior Code Revision Committee (CRC), the new Code Advisory Committee (CAC), and the Council on Dental Benefits have resulted in 84 changes: 35 new codes, 37 revised codes, and 12 deleted codes—all becoming effective on January 1, 2013.

Many of the modifications for 2013 are related to the most commonly performed dental procedures including fluoride treatments, bleaching, and crown retainer buildups. Additionally, assessment and screening codes have been added as well as codes to describe the use of an ICON™ infiltrate procedure and prefabricated ceramic crowns for primary teeth. Radiographs are now described as “images” rather than “films” to more accurately denote a digital X-ray, and many new codes have been added for the reporting of 3D images. The porcelain material description has been updated to include new materials such as the Lava Ultimate™ block. Periodontal and oral surgery codes have been added that describe the repair of bony defects associated with implants, sinus lift procedures, PRP, and a new gingivectomy code is now associated with restorative access. In the restorative and C&B sections, there are updates redefining the use of a provisional prosthesis and a deletion of the interim codes. These are just a few of the new changes in CDT 2013.

Keep in mind that the mere existence of a code does not guarantee payment. While dental benefit/insurance companies are required to recognize current CDT codes, they are not required to pay for them. It can take several years for dental benefit plans to include new codes as payable services. Even if a code is not covered initially, it is important to submit the code to the patient’s dental plan. Dental carriers review claims data are more likely to consider a code for payment if it is reported frequently.

Dr. Charles Blair is the publisher of the Coding With Confidence Manual, Insurance Solutions Newsletter, and Practice Booster Web site.

Order these breakthrough products through your Henry Schein Sales Consultant. Coding with Confidence SKU# 368-0263 Practice Booster SKU# 377-0006 (includes Insurance Solutions Newsletter)