Suggested Fee Guide Coding and Dental Claims/Plans Questions

Suggested Fee Guide Coding and Dental Claims/Plans Questions

Very helpful article posted in the April 2019 issue of Ontario Dentist by Barbara Morrow, a dental information specialist at the Practice Advisory Services at the ODA. In the article below titled “Suggested Fee Guide Coding and Dental Claims/Plans Questions”, she provides her expertise in the field by answering questions regarding the proper use of the ODA Fee Guide services codes.

www.youroralhealth.ca

 

Ten-minute units for hygiene treatment
Q. Our of ce schedules appointments using 10-minute increments of time. If my hygienist performs 30 minutes of scaling, is this coded using code 11113 or 11112?

  1. Appointments may be scheduled for 10- or 15-minute intervals, however the reporting of services related to Per Unit of Time Procedures are always measured in 15- minute units. This direction is included in item number 4 in the Preamble of the ODA Suggested Fee Guide.

If the treatment time for the procedure of scaling took 30 minutes of time, this would be coded using procedure code 11112 (two units of time).

 

Scaling appointment

Large abfraction lesions
Q. Would it be appropriate to code extremely deep, large abfraction/abrasion lesions (>2-3mm deep), as a three- surface restoration (MBD) instead of buccal due to the length of time involved and materials used?

  1. A. Regardless of the size of the restoration, if there is only one anatomical surface involved it cannot be coded as a multi-surface restoration. The fact that that the restoration is large or deep does not change the pro- cedure code or tooth surfaces treated. Where more time, responsibility, cost etc. are required to perform a service, you may wish to increase the fee charged to re ect these factors.

 

Q. We are starting to treat patients with moderate to se- vere periodontitis with an antimicrobial system they can use at home. The system requires that custom trays be made which the patient loads with an antimicrobial gel to wear between visits to the of ce. Is the correct code for this 43511?

  1. A. Procedure code 43511-9 Chemotherapeutic and/ or antimicrobial agents, topical application describes a therapeutic treatment performed in of ce. When making a custom appliance used for medication application for use by the patient, the correct procedure codes are: Medication, Custom Appliance

12701 Medication, Custom Appliance — Maxillary Arch + L
12702 Medication, Custom Appliance —Mandibular Arch + L

To report the dispensing of the antimicrobial gel beingprovided to the patient, the procedure code to use is: 96103 Dispensing, non-emergency (e.g. fluorides, vitamins, other drugs/medications +E). There is no professional fee associated with dispensing products and only the cost of the product may be passed on to the patient. Procedure code 99555 — Additional Expense of Materials, is used to report these costs.

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Q. I will be making an overdenture for a patient who is missing all lower teeth with the exception of the second premolars. I will be placing prefabricated attachments to these teeth to anchor the overdenture. What codes should be used for these services?

  1. The attachments to the premolars will be coded as follows:

28103 Prefabricated Attachment, as an Internal or External Overdenture

Retentive Device, Direct to a Natural Tooth + L and/or +E (used with the appropriate denture code) per tooth.

The appropriate denture code in the above case is as follows:

Mandibular + L, Dentures, Partial, Overdentures, Acrylic, With Cast/ Wrought Clasps and/or Rests with Independent Attachments to Natural Teeth with or without Coping Crowns.

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