Ensure Your Voice Is Heard

The “Code on Dental Procedures and Nomenclature,” also known as current dental terminology (CDT), is the nationally recognized system for reporting dental services. CDT codes—designated by the federal government via 1996’s Health Insurance Portability and Accountability Act—are the basis for reimbursement and codify the treatments available for use in dentistry.

While hundreds of procedure codes for use in dentistry exist, dental hygiene services make up only a small fraction of the nomenclature. Currently, dental hygienists also lack voting authority or organizational membership within the Code Maintenance Committee of the American Dental Association (ADA). The committee is made up of 17 organizational memberships with the ADA holding five votes. The process is open to the public, and any interested individual can submit procedure codes. New code submissions are considered annually.

The current procedure codes for scaling services for adults include: prophylaxis, scaling and root planing, periodontal maintenance, and full mouth debridement to enable comprehensive evaluation. The limited number of codes for dental hygiene services has created a gap in treatment options. Additional codes are needed to address the different lengths of time required to treat patients with varying oral health statuses. For example, a 28-year-old man who has not received professional dental care for 5 years seeks treatment in a dental practice. He has yet to lose crestal bone despite the presence of gingivitis, inflammation, bleeding on probing, plaque, and moderate calculus deposits. Dental hygienists can remove the calculus, plaque, and stain efficiently, but the time limits inherent in the codes for prophylaxis make it difficult to provide the full range of treatment this patient needs. Removing tenacious calculus from a patient who has not received a prophylaxis in years takes longer than performing a maintenance prophylaxis on a regular patient. Unfortunately, the codes don’t consider this discrepancy; thus, the practice may not receive additional payment for the patient who needs more time in the dental chair.

A study on treatment planning found that the lack of clarity in periodontal terminology and the absence of diagnostic codes in dentistry impacted diagnosis, treatment planning, and outcomes.¹ The imitations in coding for scaling and root planing may negatively impact treatment outcomes, thus, compromising coding accuracy. The proper removal of calculus can be a time-consuming procedure, especially if it is subgingival. The current codes do not acknowledge the time needed to effectively provide this treatment. It is difficult to silo patients under one code, because every patient’s condition is unique.

NEW CODE SUBMISSIONS

In the fall of 2014, three individuals submitted codes without the endorsement of an organization. The first code was submitted by a dentist and codes two and three were proposed by two dental hygienists. The ADA’s Code Maintenance Committee moved discussion of the codes to a subcommittee made up of provider associations, including the American Dental Hygienists’ Association.² The subcommittee was charged with creating a solution to the gap in the codes between prophylaxis and scaling and root planing as identified by three individuals.

The first code submission is scaling in the presence of gingival disease. This procedure is intended for patients with plaque-induced gingival diseases in the absence of clinical attachment loss. It includes removal of bacterial plaque, calculus from supragingival and subgingival regions, and stains, in addition to polishing the teeth. It is therapeutic, not prophylactic, in nature.²

The second code, which stipulates treatment of four or more teeth per quadrant, includes scaling and debridement: light, medium, and heavy. The light scaling and debridement designation includes the removal of supra and subgingival plaque, calculus, and stains when there are more than five surfaces of readily detectable calculus in the quadrant. The medium scaling and debridement designation focuses on removing supra- and subgingival plaque, calculus, and stains when there are more than 10 surfaces of readily detectable calculus in the quadrant. The heavy scaling and debridement designation relates to the removal of supra- and subgingival plaque, calculus, and stains when there are more than 20 surfaces of readily detectable calculus in the quadrant.² Implementing a graduated scale for calculus assessment with the addition of the terms “light,” “medium,” and “heavy” would ensure that treatment planning includes calculus assessment when identifying the time necessary to treat disease.

The final proposed code is scaling performed in the presence of moderate to severe gingival inflammation. This code would be limited to patients who present without any clinical attachment loss (recession, bone loss, etc).²

The subcommittee will review these options and propose one solution at the next meeting of the Code Maintenance Committee. Committee members will then vote to accept or reject the proposed solution.

SHOW YOUR SUPPORT

Dental hygienists are trained to provide dental hygiene diagnosis and dental hygiene care plans. The current procedural codes do not represent the spectrum of clinical services that dental hygienists can provide. This gap in codes challenges dental professionals in their quest to provide the best care possible to patients.

You can make your voice heard by contacting the Code Maintenance Committee in one of two ways: email a letter supporting the codes mentioned in this article to dentalcode@ada.org, or create a new code(s). Dental hygienists and others who want to submit new codes or modify existing codes must do so by November 1, 2015.

Those who support the code revisions discussed in this article can view all code submissions for 2015 online starting in mid-December of this year. Formal comments can be made during the interval between the posting of the codes and the voting period, which begins in March 2016. To learn more about the code process, visit: ada.org/en/publications/cdt/code-maintenance-committee. Thus far, the committee has received five letters supporting the need for additional codes for calculus removal, but the most effective way to impact the process is to submit a procedure code.

There are many codes that could benefit from revision to improve care delivery. As dental hygienists, we need to be part of the solution and share our perspective on how best to handle gaps in the oral health care delivery system.

REFERENCES

1. Curro FA, Grill AC, Matthews AG, et al. Case presentations demonstrating periodontal treatment variation: PEARL Network. Compend Contin Educ Dent. 2015;36:432–4340.
2. Code Maintenance Committee. Substantive Action Report, Submissions for CDT 2016. Available at:ada.org/~/media/ADA/Publications/Files/DBCQ_CMCFINALSubstantiveActionReport_2015Apr1020150410t090557.ashx. Accessed September 3, 2015.

From Dimensions of Dental Hygiene. October 2015;13(10):14–15.