Code Confusion

What often stands in the way of getting paid promptly for the work you do is the correct four-digit CDT code.  Many practices struggle with finding the right codes, and sometimes practices absorb needless write-offs.  I want to highlight three of the most common areas of code confusion.

Code D1110 is used for a regular cleaning and D4910 is used for regular maintenance after treatment for gum disease.  However, patients often pressure the front team to code a maintenance visit as a regular cleaning to receive better benefits from the insurance company.  It is important to code what you do—treatment that is supported in the chart notes—and to remember that with few exceptions most patients remain on maintenance for life following treatment for gum disease.

A number of practices struggle with implant codes and unfortunately the CDT codes are bit vague.  Since implant supported crowns attach directly, you want the front team to use D6065 – D6057.  Abutment supported implant crowns are typically coded as D6058 – D6094 along with the abutment code: D6056 for a prefabricated abutment and D6057 for a custom abutment.

It is very important to double check not only for the correct implant code, but if you are also placing an abutment to make sure the abutment is billed.  I have worked with several practices where lab fees were way out of line compared to implant revenue, and it was due to abutments not getting billed.

Finally, if you provided TMJ therapy in your practice and you offer an occlusal orthotic to alleviate pain, be sure to code that as D7880 instead of D9440, which is used for a regular night guard.

I also recommend that you subscribe to Insurance Solutions Newsletter, which is an invaluable resource for eliminating code confusion.

Comments (2)

  1. April says:

    9940 is an occlusal guard

  2. LINDA BEDFORD says:

    OUR OFFICE IS NOW LOOKING INTO USING SILVER DIAMINE FLUORIDE. I AM LOOKING AT HOW TO BE REIMUERSED FOR IT AND WHAT CODE TO USE..

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