By Dr. Charles Stewart, Aetna

It is my privilege to share with you insights and information regarding the NADP Codes Sub-WorkGroup (SWG) as part of our new Terminology Talk column.  The goal of this column is to focus on the main tasks and operations of the three SWGs comprising the Terminology, Standards and Transaction (TST) initiative and their collaborative work with outside organizations and associations.   This month, we focus on the Codes SWG.

The CDT code is vital to every dental benefit plan. The CDT code is how a provider communicates to the dental benefit plan what the procedure was, and the dental benefit plan then can adjudicate and pay or deny the claim. The CDT code is a vital communication method, that has been standardized and memorialized by the American Dental Association (ADA). This standardization has allowed the CDT code to be the only HIPAA compliant code set for dental procedures.

The CDT code set is reviewed and changes in the form of addition, deletion or revision of the current code set are made annually. The process of these changes begins with a period of submission of proposed changes to the ADA for review. These changes are distributed to each of the 22 members of the ADA Code Maintenance Committee (ADA CMC). The National Association of Dental Plans is one of the 22 members of the CMC.

The NADP Codes SWG is part of the TST volunteer groups. The Codes workgroup is made up of representatives of member plans, and include dental professionals, compliance professionals as well as Plan administrators. Our group reviews all the submissions and establishes an industry position on each proposal. That position and talking points allow for NADP being recognized as a subject matter expert and a reliable source for information about the impact of proposed changes on the operations of dental benefit plans and ultimately payments made to providers of care.

The make-up of the CMC has led to collaborative efforts among CMC member organizations to propose and debate changes to the code set. One recent example of this is the revision of the code for D0210- complete series of radiographic images which will be effective for the CDT 2023. NADP and the American Academy of Oral and Maxillofacial Radiology (AAOMR) collaboratively submitted this change, eliminating the reference to a specific number of images (14-22) from the descriptor. The collaboration allowed the proposal to pass the CMC, proving the strength of working together.

Another example of a collaborative effort is between NADP and the American Academy of Orthodontics (AAO). There were several proposals made by the AAO to the CDT codes for orthodontics. NADP member plans expressed concern on these changes, especially considering the current confusion surrounding the deletion of the CDT codes for interceptive orthodontic treatment that occurred with CDT 2022. Though the suggested changes proposed by NADP were not embraced by AAO, we were able to vet our concerns, and this resulted in a great discussion during the CMC Meeting in Chicago on March 10. Specifically, the D0351 is being deleted, with 4 new codes for direct and indirect dental image scans and facial image scans. Other AAO proposals did not pass the CMC.

A high-level overview of the CDT 2023 changes, include new codes for tomosynthesis (and the changes to the D0210 were applied in the definition of this), establishing specific CDT codes for guided tissue regeneration (resorbable and non-resorbable barrier) for each of, natural teeth, edentulous area and per implant.  There are some vaccine codes that are requested to be placed for use in CDT 2022. A complete list and change document for CDT 2023 will be available in the next few weeks.

The codes workgroup is a very dedicated group that works with laser focus to make sure any change is fully discussed, and the interest of the dental benefits industry is addressed. I would like to thank my vice chair, Kristen Strasheim, Ameritas, and our NADP Deputy Executive Director Timothy L. Brown for their guidance in all the deliberations.

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