Most Frequently Asked Coding/Claims Questions The aao dental Benefits Advisory Service (dbas) Hotline provides assistance to over 300 callers per year



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Most Frequently Asked Coding/Claims Questions
The AAO Dental Benefits Advisory Service (DBAS) Hotline provides assistance to over 300 callers per year. DBAS staff provides help with issues such as practice management situations, resolution of claims issues with payers and help with medical and dental coding questions. In recent years, almost half of the DBAS calls now focus on dental coding issues. Answers to the most commonly asked coding and claims questions have been compiled as a resource for your practice.
Q: How should our office code for more than one stage of orthodontic treatment?

A: In most cases, the most effective way to code for multiple phases of orthodontic treatment is use of Limited coding for the initial phase and Comprehensive coding for the subsequent phase. For example: if you have a juvenile patient that will require a rapid palatal expander (RPE) prior to full, active treatment, we recommend that you code the claim for the RPE as D8010 or D8020-Limited orthodontic treatment of the primary (D8010) or transitional dentition (D8020). When the more complex phase of treatment begins, an appropriate code to use would be D8080-Comprehensive orthodontic treatment of the adolescent dentition.


Q: Some dental insurance carriers/payers will not pay for more than one stage of

comprehensive treatment? Why?

A: In order to offer employers a way to save money on their employee dental benefit programs, several insurance payers have begun to “carve out” payment of this benefit from contracts they have with the employers. This has begun to be a popular option for employers…..they are able to continue to offer orthodontic benefits to their employees, but with the additional phase of treatment being excluded from payment, annual premiums are reduced.
Q: Our office is confused on when to use transitional, adolescent or adult coding. Please

explain when to use each code.

A: Generally speaking, your office would use “transitional” coding for patients that exhibit a mixture of deciduous and permanent dentition; “adolescent” coding would be used for patients approximately 12-13 years old that have shed all their primary teeth; “adult” coding would be used for those patients who are approximately 18 years of age and may or may not have third molars (wisdom teeth) erupting or in place.
Q: What code would our office use for delivering a retainer?

A: If a patient has just completed active treatment and had their braces stripped,

the code to use would be D8680-Orthodontic retention (removal of appliances,



construction and placement of retainer(s). If your patient is a few months out of

active treatment but has lost their retainer, the code “D8692-Replacement of lost or



broken retainer would be used. Finally, if a patient who is several years out of

treatment presents (perhaps their teeth have shifted, etc.) we would recommend use

of Limited Orthodontic treatment coding. You would simply use the code that best

describes their stage of dental development. For example, if your patient is an adult,

the recommended code would be D8040-Limited orthodontic treatment of the adult

dentition.
Q: What code(s) would our office use for submitting orthodontic diagnostic records and the consultation appointment?

A: Depending upon what records are actually taken by your office, we recommend that

the claim be submitted using all of the following codes that are applicable:



D0150-Comprehensive oral evaluation-new or established patient

D0220-Intraoral-periapical first film

D0230-Intraoral-periapical each additional film

D0330-Panoramic film

D0340-Cephalometric film

D0350-Oral/facial photographic images

D0470-Diagnostic casts-also known as diagnostic models or study models

D9450-Case presentation, detailed and extensive treatment planning-established

patient. Not performed on same day as evaluation



Q: What code(s) would our office use for use of temporary anchorage devices (TADs)?

A: The TAD codes are as follows; select the code appropriate for the case.

D7292-Surgical placement: temporary anchorage device (screw retained plate)

requiring surgical flap. Insertion of a temporary skeletal anchorage device that is

attached to the bone by screws and requires a surgical flap. Includes device removal.

D7293-Surgical placement: temporary anchorage device requiring surgical flap.

Insertion of a device for temporary skeletal anchorage when a surgical flag is required.

Includes device removal.

D7294-Surgical placement: temporary anchorage device without surgical flap.

Insertion of a device for temporary skeletal anchorage when a surgical flag is not required.

Includes device removal.
Q: What code(s) would our office use when space maintainers are placed?

A: D1510-Space Maintainer-fixed, unilateral

D1515-Space Maintainer-fixed, bilateral

D1520-Space Maintainer-removable, unilateral

D1525-Space Maintainer-removable, bilateral

D1550-Re-cementation of space maintainer

D1555-Removal of fixed space maintainer-procedure delivered by dentist who did not



originally place the appliance, or by the practice where the appliance was originally

delivered to the patient.
Q: How do you handle professional or family discounts when submitting claims?

A: When offering discounts to patients you must disclose the discount to payers. The

recommended way to submit the information is via the claim form. On the initial claim

form, simply list your fee, note the discount and subtract that amount from the total fee

charged. If, for some reason, over the course of treatment you decide to write off a patient balance, you will need to notify the insurance carrier as well.



Q: How is the best way to submit an initial claim for treatment?

A: When submitting the initial claim for treatment, it is a good idea to establish exactly how

your office expects the case to be handled financially. On the claim form, be sure to include



the following components:

  • Appropriate CDT code

  • Total treatment fee

  • Subtract down payment and/or discounts, if any

  • Indicate the months of expected treatment and indicate payment amount and mode (monthly, quarterly, etc.); most offices pro-rate the remaining balance after down payment over the months of treatment


Q: How is the best way for our office to handle a case in which a child’s parents are divorced?

A: Our recommendation is to consider the parent who presents the child for treatment as the “responsible party”. Execute the treatment contract with that parent and make them your “point person” for the case, trying to deal with them exclusively. It is very important to remain neutral in the event of any acrimony or disagreements between the parents. Your office must keep yourselves out of the middle of any issue that may arise.

The AAO sponsors the DBAS Hotline as a member service for you and your staff. We are happy to help in any way possible. The Hotline is available from 8:00 AM to 5:00 PM Monday through Friday and can be reached by calling (800) 424-2841 X582 or by email at asebaugh@aaortho.org.


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