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CDT Codes and How It Impacts Reimbursements

By Shelley DeGroff, Founder of PPO Advisors

As a dental provider, the more you understand about how your practice generates revenue, the better. With that in mind, let’s take a short walk into the weeds by talking about Current Dental Terminology (CDT) code and how it can impact insurance reimbursements.

Purpose of the CDT Code

A common misconception is that the CDT code comes from insurance companies – it doesn’t. It’s a reference manual published by the American Dental Association (ADA), who owns the copyright. The purpose of the code is to support uniform, consistent and accurate documentation of dental services on dental claims, electronic health records and patient treatment plans. The CDT categorizes codes by type of service, such as diagnostic, preventive, restorative, endodontics, periodontics, etc. Every year the ADA publishes an updated version that’s intended to better reflect the current practice of dentistry.

Prioritize Top 10 Codes

At many practices, 10 codes are responsible for 90% of revenue. Knowing which codes those are puts you in a better position to negotiate with the insurer. At PPO Advisors, when we conduct a free analysis for a potential client, we focus on the most frequently used codes in our negotiations with insurers. That gives us the ability to rearrange the fee schedule to prioritize those codes.

Implement New Code into Existing Fee Schedule

When the ADA comes out with its updates each year, you should make a point to review and implement the new codes as quickly as possible. If you’re happy with your current fee schedule, you have the option to negotiate an individual code with your insurer. To figure out the pricing for a new code, the best way is through zip code analysis. You should be able to do this through Fair Health, a nonprofit clearing house for private dental claims data that can provide pricing information for all the codes submitted in your zip code. Accessing the information will give you a good idea of how to price the new codes.

Proper Training Prevents Problems

Some dental professionals report never having been formally trained in coding and are unfamiliar with how to do it correctly. Proper training is crucial, not only because it can impact revenue, but also for the potential to inadvertently commit fraud.

A common problem occurs when a claim is submitted with a code that doesn’t match the service provided. The insurer can deny the claim and bounce it back to your practice, where your staff ends up spending more time dealing with it. This avoidable situation can delay reimbursements by weeks or even months. It’s far more efficient to get it right the first time.

Another frequent occurrence is when improperly trained staff incorrectly codes a treatment that results in reimbursements that are lower than the provider is entitled to. I’ve seen offices that were in the habit of billing for a regular exam when they were actually providing periodontal treatment, which was reimbursed at a higher rate. Codes should always reflect the services performed based on the patient’s diagnosis and individual need.

CDT Changes in 2022

In its 2022 update, the ADA approved 16 additions, 14 revisions and six deletions to the CDT code. The changes cover a range of services, such as pre-visit patient screenings, sleep apnea appliances, and immediate partial dentures. To stay current, we recommend your office keep a current ADA CDT book on hand and that both the business and clinical staff understand proper coding procedures.

If you’d like to learn more about how to prioritize your top 10 codes or implement code changes for 2022, contact PPO Advisors today. We’re committed to helping dental providers work smarter not harder.

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