A number of changes to the ADA's Code on Dental Procedures and Nomenclature (CDT), and the process by which the codes are maintained, are slated to take effect in 2013.
The purpose of the CDT is "to achieve uniformity, consistency and specificity in accurately reporting dental treatment," according to the ADA. One use of the CDT Code is to provide for the efficient processing of dental claims, but more broadly, the code defines the procedures used in dentistry.
The inclusion of a code does not in itself ensure insurance coverage. Dental insurance coverage depends upon the contract between the insurance company and the patient. However, the absence of a code makes claims for payment problematic. Since August 17, 2000, the CDT Code has been a HIPAA requirement for any claim submitted on a HIPAA standard electronic dental claim, and it must use the version of the CDT Code in effect on the date of service. The CDT Code is also used for paper dental claims.
The ADA's Council on Dental Benefit Programs is responsible for CDT Code maintenance, and until late 2011 the process of CDT Code maintenance and updates was a court-ordered balance between six dentist volunteers appointed by the ADA and an equal number of representatives from key third-party payors, with change requiring either a simple or super majority. While it was possible to take a 6:6 vote tie to arbitration, this was not frequently resorted to.
Broadening the base
Code maintenance is now achieved through the new Code Maintenance Committee (CMC), which includes representatives from various sectors of the dental community: five ADA representatives, five payor representatives (including Centers for Medicare and Medicaid Services), and 11 other stakeholders who were excluded from the previous process.
"One complaint regarding the code maintenance process was that the code was not responsive to the evolving needs of dentistry and that the profession would be better served if needed changes to the code were not delayed two years," according to an ADA spokesperson. "The new committee ... is more inclusive of a broader range of stakeholders, while maintaining the necessary voice of the insurance industry."
The committee's role is the same -- making final decisions on code change requests -- but the process has been expanded to include an open hearing at the ADA annual session and a portion of the annual CMC meeting devoted to gathering input from the public, the ADA noted.
"The multistakeholder group studies, discusses, and decides on all changes to the code, in a process that is open to the public, fair, and transparent," the ADA spokesperson explained.
Requests for CDT Code additions, revisions, or deletions may be submitted by anyone at any time. CDT Code review and revision are made on an annual cycle, with each successive version effective on January 1 of the following year. Visit the ADA website for more details about the process.
New and revised codes
The construction of CDT 2013 occurred over a two-year period. It includes 35 new codes and 37 revised codes; in addition, 11 codes have been deleted. The format is streamlined and simplified.
One portion of the codes that is greatly changed is the subcategory of Diagnostic Imaging. This portion has followed technological change in replacing the term "film" with "radiographic image." Further, there is a wider range of categories for cone-beam CT based mainly upon field-of-view and anatomic site, and it is possible to code for these either with the interpretation included or for technical service alone. In addition, there are new codes for maxillofacial ultrasound, maxillofacial MRI, and sialoendoscopy, plus a code for the professional service radiographic reads and reports separate from the technical service when this is applicable.
"The imaging procedure codes were revised to provide a more accurate means of recording images in a world of changing technology," according to an ADA spokesperson. "The imaging codes are diagnostic procedures, not diagnostic codes. Diagnostic concepts are in other terminologies such as SNODENT [Systematized Nomenclature of Dentistry] and ICD-9 [International Classification of Diseases, Ninth Revision]."
The CDT 2013 is available for purchase from the ADA; visit the ADA Catalog for more information.
The CDT 2014 development process is already under way. The submission deadline was November 1, 2012, and the CMC will meet to discuss these submissions in late February and early March 2013.
