Clinic Theory Ii Dental Codes

Front 1

What does CDT stand for?

Back 1

Current Dental Terminology

Front 2

What is the purpose of CDT codes?

Back 2

To achieve uniformity, consistency & specificity in accuratel reporting dental Tx.
*One use of the CDT codes is to provide for the efficient processing of dental claims.*

Front 3

What does HIPAA stand for?

Back 3

Health Insurance Portability & Accountability Act

Front 4

HIPAA requires proper reporting of dental codes.
What are some examples of Dental Fraud?

Back 4

Billing for services not provided
Reporting a higher level of dental service than was actually performed-->"Up-Coding"
Submitting a dental claim under one Pt's name when services were provided to another person.
Billing for non-covered services as if they were covered.
Performing services that are not suitable or necessary.

Front 5

Codes ending in 99 of 999 are _____-__________--.

Back 5

non-specified "D4999"

Front 6

If you're using a non-specified code what do you need to do when submitting for billing?

Back 6

Include a narative,

Front 7

What are the components of a code entry?

Back 7

Procedure code-->5 Character alphanumeric beginning with D
Nomenclature-->Written title of the procedure.
Descriptor-->Narrative providing further definition & intended use of the procedure. (Most but not all codes have a descriptor.)

Front 8

What are 5 services that are usually not covered by insurance?

Back 8

1) Intra Oral Photo's-->except as part of an ortho record component.
2) Caries susceptibility-->saliva testing
3) Smoking Cessation Counseling
4) Nutritional Counseling for control of dental diseases
5) OHI

Front 9

If a difficult class I or II Pt comes in for Tx that hasn't been seen in a while, how might the DDS bill for this PT who takes more time?

Back 9

They can bill for highter fee for 1 long appt or they can bill the D1110 code twice if its handled in 2 appts…but its not ususally covered.

Front 10

How are sealents usually billed?
Which teeth are always vs sometimes covered?

Back 10

Sealents are billed per tooth.
Molars are always covered. PM's are sometimes covered.
*Remember sealants are usually only covered up to a certain age on the Pt.**

Front 11

Why is the Full Mouth Debridement code of D4355 considered a 4 letter word in DH?

Back 11

Because its only used if teeth have so much calc on them that it interferes with the ability of the dentist to perform a comprehensive exam.
*Typically once the supra Calc is removed then actual data (Perio measurements etc) can be taken. Pt feels their teeth are clean since they can't see the Sub G calc and they don't return for the next appt to have it all removed.*
**Its better to work one quadrant at a time, get the data and then move to the next quadrant to ensure PT compliance.**

Front 12

If Arestin (D4381) is going to be provided when is the best time to provide it and get reimbursed for the service?

Back 12

At the 6 week re-eval.

Front 13

If using the code 4999 for Chlorhexidine use after SRP, what might need to be included with the billing?

Back 13

A narrative.

*Remember, any code ending in 99 or 999 probably is going to require a narative.*

Front 14

Can Pt's be considered both a D4910 Periodontal maintenance & a D1110 Prophylaxis adult over 14?

Back 14

NO!
They are not interchangeable codes.
The PT is either one or the other. If the PT heals and becomes a D1110 but would need to be Scaled & Root planed again in order to code as a D4910 again.