What is CDT?
It is a reference manual published annually by American Dental Association (ADA), contains all the dental codes required to code each dental procedure(s) for submission to dental insurance plans. The CDT dental code is a set of procedural codes for oral health and adjunctive services that are provided in dentistry.
Structure and Categorization of CDT codes:
The CDT procedural code consists of an alphanumeric character beginning with the letter “D” (the procedure code) and a title (the nomenclature). It also includes written narratives (descriptors) for some of the procedural codes.
Example: D7230 removal of impacted tooth – partially bony
The CDT Code categorizes codes by type of service as below:
- D0100-D0999 DIAGNOSTIC
- D1000-D1999 PREVENTIVE
- D2000-D2999 RESTORATIVE
- D3000-D3999 ENDODONTICS
- D4000-D4999 PERIODONTICS
- D5000-D5899 PROSTHODONTICS (removable)
- D5900-D5999 MAXILLOFACIAL PROSTHETICS
- D6000-D6199 IMPLANT SERVICES
- D6200-D6999 PROSTHODONTICS (fixed)
- D7000-D7999 ORAL & MAXILLOFACIAL SURGERY
- D8000-D8999 ORTHODONTICS
- D9000-D9999 ADJUNCTIVE GENERAL SERVICES
When should you use CDT codes?
Generally providers have three types of coverage options for billing:
If you submit a dental benefit claims as either an in-network or out-of-network provider, or engage in electronic communications or transactions that fall under HIPAA, you would use the CDT dental codes. The U.S. federal government has designated the CDT Code as the national terminology that must be used for reporting dental services on claims to third-party payers.
How do dental practices submit claims using CDT dental codes?
As you are aware that medical claims are submitted on their own claim form (CMS 1500 form); dental claims utilizes the J400 form. This form is specifically designed to accommodate dental information. The following must be included on dental claim forms:
- Area of oral cavity
- Tooth system
- Tooth number or letter
- Tooth surface
- Description of procedure
- Missing teeth information
Key considerations to determine CDT or CPT codes:
Billing dental services: CDT procedure codes are used when reporting dental procedures to a dental payer. The standard practice is to submit the dental claim first and then, if it is denied, you can submit a medical claim. Many medical payers will accept the CDT code when there is no applicable medical cross code (CPT) or when the CDT is the most accurate code to describe the dental procedure performed. However, it is advisable to contact the medical payer prior to claim submission to determine if submission of CDT codes is allowable per their policies.
Type of coverage: Another major factor determining CDT vs. CPT code use is the patient’s coverage type. To assign a CDT dental code on the claim for a dental procedure, the patient must have dental insurance. However, based on the patient’s insurance policy coverage, medical insurance can be billed if the patient received dental care related to a medical condition. Examples of dental procedures that can be billed to medical insurance would include:
- All oral and dental procedures associated with any kind of traumatic injury to the mouth
- Exams and consultations when oral cancer screening is done, and in preparation for any other medically billable procedure
- Emergency treatment of oral inflammation and oral infections
- Diagnostic, radiographic, and surgical or healing stents
- Radiographs for certain screening and diagnostic purposes
- Biopsies and excisions, including smears and brush biopsies
- Surgery associated with interim and final prostheses necessitated by a traumatic injury
- or any medical condition
Medical-dental cross coding:
When you bill to Medical insurance which do not accept CDT codes, you need to submit a compatible medical code. This can be identified by cross referencing with the CPT book.
Examples of procedures that have a compatible CPT code are:
- Alveoloplasty w/ extractions per quadrant D7310 / 41874
- I & D of abscess – intraoral soft tissue D7510 / 41800
Tips to successful dental billing:
Failing to use accurate CDT codes in the claims will cause payment delays and denials and also increase fraud risk. Here are few tips for successful dental billing:
- Use the most precise and up-to-date code to reflect the procedure performed. The CDT Code that is valid on the date of service should be reported.
- Necessary documents such as narratives and radiographs should be submitted. The narratives should be clear and concise, and state the diagnosis and reason why the procedure was performed.
- Patient’s demographic details such as birth date, Social Security number, and insurance policy and group numbers must be entered correctly.
Happy learning! Happy coding!