Impacts of Diagnostic and Procedure Coding on the Dental

Industry

Tuesday, Sept. 13 / 1:30 – 2:30 pm

2

CHARLES D. STEWART, DMD

Aetna, Dental Director - West Dental Territory NADP Codes WorkGroup Chair

NADP Delegate to CMC

CDT- The Code on Dental Procedures and Nomenclature

• CDT Book (e-book as well!) Published by the ADA

• Process to Add, Delete, Revise a code managed by the ADA

Brief History of the CDT Process

• Originally 12 member Committee - 6 members from ADA and 6 members from Payer organizations

• Format was characterized by backroom caucuses during deliberations on proposed changes and many times resulted in tie votes; rendering defeat to many submissions which had merit.

Brief History of the CDT Process

• Evolved to current 21 member committee- 6 members from ADA and 15 members representing all specialties as well as payer and professional organizations

– Format allows more collaboration among committee members and promotes open candid discussion during deliberations on proposed changes. This format also provides a platform for public input in the process.

Brief History of the CDT Process

• August 2000 the CDT was designated by the Federal Government as the national terminology for reporting dental services on claims submitted to third party payers, in accordance with the authority granted by the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

• CDT is the ONLY HIPAA compliant code set for reporting dental procedures

Brief History of the CMC

• Code Maintenance Committee (CMC)

• Process changed from bi-annual process to annual process in 2012

• Which means:

New CDT codes EVERY year

Plans must be able to accept claims with new codes effective January 1 every year

Annual meeting in Chicago (late February-early March)

Trends in CDT submissions

• Original proposals would be for procedures performed, and often encompassed changes to, or introductions of different materials used in dentistry

• Recent trends toward technique or instrument (i.e.- laser)

Codes for Technique or Instrument

Trends in CDT submissions

• CDT Codes for Compliance with regulatory issues or requirements

- The Affordable Care Act (ACA)

- State Specific Requirements (Taxes, Regulatory Access)

- CMS Compliance

Codes for Compliance

• Pre-diagnostic services

D0190 screening of a patient (CDT 2013)

D0191 assessment of a patient (CDT 2013)

• Non-clinical procedures

D9985 Sales Tax (CDT 2014)

D9986 Missed Appointment (CDT 2015)

D9987 Cancelled Appointment (CDT 2015)

Codes for Compliance

• NEW in CDT 2017 D9991 dental case management- addressing

appointment compliance barriers

D9992 dental case management- care coordination

D9993 dental case management- motivational interviewing

D9994 dental case management- patient education to improve oral health literacy

Trends in CDT submissions

• Diagnosis included in CDT code itself

• Difficulty introduced into description

• Actors included in CDT code itself

• Products / Proprietary Submissions

Diagnosis in the CDT code

D1352 preventive resin restoration in a moderate to high caries risk patient - permanent tooth (CDT 2011-2012)

D2981 inlay repair necessitated by restorative material failure (CDT 2013)

D2982 onlay repair necessitated by restorative material failure (CDT 2013)

D2983 veneer repair necessitated by restorative material failure (CDT 2013)

D2990 resin infiltration of incipient smooth surface lesions (CDT 2013)

Diagnosis in the CDT code

D6103 bone graft for repair of peri-implant defect- does not include flap entry and closure (CDT 2013 / Revised CDT 2016)

D6104 bone graft at time of implant placement (CDT 2013)

Diagnosis in the CDT code

• NEW in CDT 2017

D4346 scaling in the presence of generalized moderate or severe gingival inflammation- full mouth, after oral evaluation

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

Diagnosis in the CDT code

D2980 crown repair necessitated by restorative material failure (Revised CDT 2013)

D2981 inlay repair necessitated by restorative material failure (CDT 2013)

Trends In CDT Submissions

• Difficulty in description

Difficult prophy (not approved)

• Actors in CDT code itself

D7997 appliance removal (not by dentist who placed appliance) includes removal of archbar

D9311 (CDT 2017) consultation with a medical health care professional

Trends In CDT Submissions

• Products / Proprietary Submissions

D2990 resin infiltration of incipient smooth surface lesions

D0600 (CDT 2017) non-ionizing diagnostic procedure capable of quantifying, monitoring, and recording changes in structure of enamel, dentin and cementum

20

ROGER ADAMS, DMD, MBA

NADP Delegate to IHTSDO,

Dentistry Special Interest Group (SIG)

21

Diagnostic Codes for Dentistry

Diagnostic Codes- Why SNODENT?

An official subset of SNOMED CT – a vocabulary designed for use in the electronic environment

• Provides standardized terms for describing dental disease

• Capture clinical detail and patient characteristics

• Interoperable with Electronic Health Record (EHR) and Electronic Dental Record (EDR)

• Allows analysis of patient care services and outcomes

22

Diagnosis? Treatment? Outcome?

23

24

25

THE HISTORY OF SNODENT

It is a Renaissance!

2626 26

1998

Toronto

Codes

1999

Z Codes

2015

27

SNODENT (~7,000 codes)

Systemized Nomenclature of

Dentistry – Comprehensive

clinical terminology for

Dentistry that includes

diagnosis, findings and

anatomy

SNODDS (~1,500 codes)

Comprehensive Dental

Diagnostic Terminology for

use in EHR user interfaces

SNODDSGD (~300 codes)

Diagnostic Terminology

tailored for the General

Dentist for use in EHR user

interfaces

Why 3 different restorations?

28

29

Long term benefits of dental sealants in dental decay abatement and prevention?

30

Early Adopter Stage

• 71% of US Dental Schools are currently using a standardized documentation of diagnosis in the electronic health record

• Several DSOs working with public programs and research have incorporated diagnostic codes

• The VA and some DMOs are adopting dental diagnosis

• Federally Qualified Health Centers (FQHCs) are needing to use SNODDS to convert to ICD for payment (and surviving the Recovery Audit Program)

31

New Era

• Dental Schools are integrating SNODDSGD

• SNODENT is now part of SNOMED CT administered by IHTSDO

• SNODDSGD (~300 diagnostic codes) will be incorporated into SNOMED CT by the end of 2016

• “Crosswalks” that match diagnostic codes to ICD-10 are being developed by the ADA enabling practice management software to transmit ICD-10 information to payer organizations.

• Payers Capturing and Aggregating Diagnosis Codes

32

New EraWith relevant diagnosis tied to procedure codes this information will be the basis for:

• Streamlined adjudication of claims

• Examination of populating health

• Regional differences in disease patterns

• Changes to dental benefits

• Improving cost of care

33

A Lot Has To Happen

• Dentists have to be educated about the use of diagnosis codes

• Practice management companies need to enhance their platforms to integrate diagnostic codes

• Payer organizations need to be able to capture and aggregate this information

34

The Future

• CDT Codes may need revision or deletions to remove the diagnostic information currently embedded into the code

• Outcomes can be obtained based on the diagnostic codes- ex: crown replacement reason from diagnostic code (recurrent decay, fracture, open margin, lack of contact, change in occlusion etc.)

The Future

• Meaningful ranking and rating of provider quality

• Objective Provider Report Cards

• Effective Cost analysis and relation to risk factors (both the patient as a risk and provider as a risk)

• Meaningful Actuarial Analysis for Plan design

• Potential development of high quality cost effective networks

The Future

• CDT Codes are truly procedure codes

• Diagnostic codes are key to procedures, design and pricing of dental plans

• Quality of network improved due to accurate identification and correction of providers with repeat quality or outcome issues.

What do we need to do?

The foundation is being laid.

It is now the job of each sector to do the appropriate education and

outreach so all parts of the process are connected.

38

39

QUESTIONS & ANSWERS

4040

The more sessions you rate, the more times you are entered to win one of three gift cards!

(Valued at $100.00 each)

41

In the Mobile App• Log in

• Click the “Schedule” icon

• Select this session

• Rate 1-5 stars

Online• Go to nadp.org/CON16app

• Log in

• Select “Schedule” on in the left column

• Select this session

• Rate 1-5 stars

Rate this Session