Insurance expert Dr. Doyle Williams is back to help you with your coding dilemmas. In this column, he answers some of your questions submitted via email, including those on topics such as crowns and bridges, bone grafts for ridge preservation, and grafting with bone materials.
Q: I am dental lab owner and need some information regarding codes for crown and bridges. Code D2794 is for a titanium crown. As per ADA regulations, a titanium crown should have at least 85% titanium. My question is can any dentist tell the difference from x-ray about titanium and regular porcelain fused to metal (PFM) (NP, S/P or HN)?
A: The titanium crown is rarely ever used. The code was created so all metals could be represented, but it is not a practical all-metal crown. A UCR (usual, customary, and reasonable) has not been developed because nobody uses the code, so it would probably reimburse like a semiprecious crown. The initials stand for nonprecious, semiprecious, and high noble and refer to the gold content used.
Q: We are an R&D company based in New Zealand and are trying to get a better understanding of which code our product would fit under for reimbursement. The OVC ("one visit crown") is a new dental product and procedure to restore broken teeth. The procedure is done primarily indirectly and is a resin-based composite.
In terms of dental insurance reimbursement, we are currently checking under which CDT code our product would fall. We feel that D2664, onlay resin-based composite four or more surfaces, would be the code for which it would be best-suited.
A: The answer is easier than it appears. The correct code is indeed D2664 as suspected.
Q: We are having some discussions about extraction site preservation Code D7953. There are several ways to enhance extraction site sockets, but it seems there is only one code for the treatment.
The enhancement of healing of an extraction site can be done with many materials and sutures, including Gelfoam (maybe with a little tetracycline powder), collagen plug, Foundation bone enhancement by J. Morita, Bioplant by Kerr, grafting with bone material (allograft, autograft, xenograft), collagen membrane, and so on. It seems that dentists use code D7953 for any of those. My question: Is there more than one code for these procedures?
A: There is only one code, and the nomenclature says it is a bone graft for ridge preservation, so bone must be used. It can be an allograft or autograft.
Doyle Williams, DDS, spent 24 years as an insurance executive and is now vice president of carrier relations and insurance operations for Aspen Dental.
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