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6.20.08 Issue #328 Forward This Newsletter To A Colleague

Carol Tekavec
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No Special Codes for CAD/CAM Restorations

Are there special codes for CAD/CAM restorations? Many dentists and staff would prefer it. CAD/CAM technology is expensive, and it has an implementation learning curve that also must be considered. Of course, CAD/CAM technology is quicker; patients may receive one-day service for inlays, onlays and crowns. This convenience alone suggests the appropriateness of a designated code sequence for CAD/CAM. Because CAD/CAM technology is cutting edge, a higher reimbursement from insurance carriers might be reasonable.

The reality is, however, that there are no special codes for CAD/CAM restorations. The ADA coding system is revised every two years. (The current codes are good for 2007–2008. New codes will be available in my ADA-licensed Dental Insurance Coding Handbook: 2009–2010 Addendum in a few months.) Although it is under the jurisdiction of the ADA, the Code Revision Committee contains representatives of both the dental profession and insurance carriers.

Under HIPAA (Health Insurance Portability and Accountability Act) regulations, the ADA CDT code set contains the only dental codes available for use on claims and records, which are to be used by everyone—dentists and insurance carriers alike—when reporting dental treatment. (Medical codes may be used to report medical procedures on the appropriate medical claim forms, when submitted by either physicians or dentists.)

Crowns, bridges, veneers, inlays and onlays, no matter how they are made, are all covered by CDT 2007–2008 procedure codes. Some of these codes mention the generic material used, such as resin-based composite or porcelain-fused-to-high-noble metal. However, the codes do not reflect a specific brand of product or material, or a certain technique. This means that there are currently no codes to describe providing a service by means of a laser, nor are there any codes to describe the manufacture of a crown by means of computer-assisted technology, such as CEREC. There are also no codes to apply to a certain brand of porcelain or resin.

Some Codes and Definitions
An inlay is defined by the ADA as an intracoronal restoration made outside the mouth to correspond to the form of the prepared cavity. It is then cemented or light-cured into the tooth. An onlay is defined as a restoration made outside the mouth that replaces the cusp or cusps of a tooth. It is not considered correct to report an inlay code along with an onlay code. The onlay code is inclusive of the inlay.

Inlays and onlays are currently reported using codes D2510–D2664. Crowns are reported using codes D2390 and D2710–D2799, including those made with indirect composite. Veneers are reported using codes D2960–D2962. Any restoration that does not fit a designated code description can be reported using D2999 with a narrative. (Remember that “99” codes are often flagged for review by an insurance consultant. This may delay the claim but, after the review, may qualify the claim for payment.)

CEREC and other CAD/CAM restorations may include different variations of expected restorative configurations for inlays, onlays and crowns. For example, some CAD/CAM configurations are described in the literature as “overlays.” The word “overlay” is mentioned in the ADA definition for an onlay, but is not described as a separate restoration.

CAD/CAM dentists may use the word “overlay” to describe a restoration replacing the MDFO surfaces of a tooth. Codes that might apply include D2712-Crown-3/4 Resin Based Composite, Indirect; D2783-Crown-3/4 Porcelain/Ceramic; and D2999-Unspecified Restorative Procedure, by report. CAD/CAM or not, dentists should be aware of the current CDT codes for indirect resin-based composites. D2650–D2664 can be used for reporting indirect resin based inlays and onlays, indirect resin crowns can be reported using D2710-Crown-Resin Based Composite.

Some dentists may think that separate CAD/CAM codes would result in better payment for these procedures from insurance carriers. After all, CAD/CAM technology is expensive and intricate. However, it is likely that the opposite might happen. Without a lab fee expense, CAD/CAM restorations might be argued to be actually less expensive than lab-fabricated restorations. (Some labs also utilize CAD/CAM technology, which could further complicate the argument.)

Although some maintain that separate codes for CAD/CAM restorations should be developed, it is not expected that this will happen for the next code revision. Certain criteria exist for new code developments which, among other things, include new materials or a service that is seeing an increase in frequency.

Even though new materials are being developed all the time, and CAD/CAM technology is certainly on the rise, those who have suggested code changes have not seen them adopted. Individual dentists who are not satisfied with current codes may always make suggestions for new codes at the website. Such suggestions would be too late for 2009–2010 revision, but they could be considered for 2011–2012.

With 34 years in the dental field, Ms.Tekavec is the President and owner of Stepping Stones to Success. She is a well-known author and lecturer. She has appeared at all of the nation’s top dental meetings, as well as providing programs for dental societies and study clubs. Still practicing as a hygienist clinically, she is a consultant with the ADA Council on Dental Practice, and was the columnist on insurance for Dental Economics magazine for 11 years. She is the author of the Dental Insurance Coding Handbook, and a bestselling patient brochure series.

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