Cracking Periodontal Codes Resourcecodha.org/wp-content/uploads/2017/09/Cracking-Periodontal-Codes-Resource.pdfA new classification scheme for periodontal and peri-implant diseases

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Cracking Periodontal Codes with Class: Diagnostic Decisions Speaker: Katrina M. Sanders RDH, BSDH, M.Ed, RF

Caton J, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions – Introduction and key changes from the 1999 classification. J Periodontol. 2018; 89 (Suppl 1): S1-S8.

Periodontal Health, Gingival Diseases & Conditions

Periodontitis

Periodontal Health & Gingival Health

Gingivitis: Dental Biofilm-Induced

Gingival Diseases:

Non-Dental Biofilm-induced

Necrotizing Periodontal

Diseases

Periodontitis Periodontitis as a

manifestation of Systemic

Disease

Other Conditions Affecting the Periodontium

Systemic diseases or conditions

affecting the periodontal supporting

tissues

Periodontal abscesses and

endodontic-periodontal

lesions

Mucogingival deformities and

conditions

Traumatic occlusal forces

Tooth and prosthesis

related factors

Peri-Implant Diseases and ConditionsPeri-implant Health Peri-implant Mucositis Peri-implantitis Peri-implant Soft and

Hard Tissue Deficiencies

Stage Stage I Stage II Stage III Stage IV

Severity Interdental CAL

1-2mm 3-4mm 5mm or less 5mm or more

RBL Coronal third (<15%)

Coronal third (15%-33%)

Extending to mid-third of root and beyond

Extending to mid-third of root and beyond

Tooth loss No tooth loss due to periodontitis

Tooth loss due to periodontitis

Tooth loss due to periodontitis

Complexity Local Max probing depth 4mm

Mostly horizontal bone loss

Maxi probing depth 5mm

Mostly horizontal bone loss

In addition to Stage II:

Probing depth 6mm

Vertical bone loss

Furcation involvement cls II or III

Moderate ridge defect

In addition to stage III:

Need for complex rehabilitation due to:

Masticatory dysfunction

Secondary occlusal trauma

Severe ridge defect

Bite collapse, drifting, flaring

Less than 20 remaining teeth

Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018; 89 (Suppl 1): S159-S172.

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This slide contains content from the "ADA Guide to Reporting D4346" that is protected by copyright (©2018 American Dental Association (ADA). All rights reserved)

Licensed to use ADA CDT codes granted to Katrina Sanders, enabling the speaker and host association to present CDT Codes. The Code on Dental Procedures and Nomenclature is published in CDT 2018 Current Dental Terminology, Copyright 2018, American Dental Association (ADA) All rights reserved.

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New Trends in Coding HbA1c in-office point of service testing

n This code is to be used when drawing a blood sample and performing point of service analysis of the sample by a dentist

n D0411 n Submitted by Delta Dental Plans

Teledentistry – synchronous; real-time encounter

n D9995 n Separate procedure documented and reported in addition to other procedures (e.g., diagnostic)

delivered to the patient on the date of service. n Submitted by American Dental Association: Council on Dental Benefit Programs

Teledentistry – asynchronous; delayed encounter

n D9996 n Separate procedure documented and reported in addition to other procedures (e.g., diagnostic)

delivered to the patient on the date of service. n Submitted by American Dental Association: Council on Dental Benefit Programs

Interim caries arresting medicament application – per tooth

Licensed to use ADA CDT codes granted to Katrina Sanders, enabling the speaker and host association to present CDT Codes. The Code on Dental Procedures and Nomenclature is published in CDT 2018 Current Dental Terminology, Copyright 2018, American Dental Association (ADA) All rights reserved.

Peri-Implant Health

Peri-Implant Mucositis

Peri-Implantitis Peri-Implant Soft and Hard Tissue Deficiencies

Mucosa is keratinized or non-keratinized

Inflammatory lesion of the soft tissue surrounds implant

Bleeding on probing & visual signs of inflammation.

Reversible with plaque elimination

Pathological condition characterized by plaque-induced inflammation of the peri-implant connective tissue and subsequent progressive loss of supporting bone

Contributed by etiological factors: systemic disease, medications, tissue turnover, trauma, local disease, biochemical factors, tissue morphology

Intrabony aspect is in contact with mineralized bone

Absence of supporting bone or continuing marginal bone loss

Progressive loss of supporting bone

Loss of support from mechanical or idiopathic means

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n Verbiage: conservative treatment of an active, non-symptomatic carious lesion by topical application of a caries arresting or inhibiting medicament and without mechanical removal of sound tooth structure

n Revise D1354 code n The Code Maintenance Committee determined that the submissions’ proposed wording change

clarifies the procedure’s intended nature and scope. n Submitted by American Academy of Pediatric Dentistry

2019 CDT Codes D0421

n blood glucose level test – in-office using a glucose meter n This procedure provides an immediate finding of a patient’s blood glucose level at the time of sample

collection for the point-of-service analysis. D9613

n infiltration of sustained release therapeutic drug – single or multiple sites n Infiltration of a sustained release pharmacologic agent for long acting surgical site pain control. Not for

local anesthesia purposes. Occlusal Guards

n D9944 | occlusal guard – hard appliance, full arch n Removable dental appliance designed to minimize the effects of bruxism or other occlusal

factors. Not to be reported for any type of sleep apnea, snoring or TMD appliances. n D9945 | occlusal guard – soft appliance, full arch

n Removable dental appliance designed to minimize the effects of bruxism or other occlusal factors. Not to be reported for any type of sleep apnea, snoring or TMD appliances.

n D9946 | occlusal guard – hard appliance, partial arch n Removable dental appliance designed to minimize the effects of bruxism or other occlusal

factors. Provides only partial occlusal coverage such as anterior deprogrammer. Not to be reported for any type of sleep apnea, snoring or TMD appliances.

Additional Codes:

n D5876 | add metal substructure to acrylic full denture (per arch) n D9990 | certified translation or sign-language services – per visit n D9961 | duplicate/copy patient's records

Licensed to use ADA CDT codes granted to Katrina Sanders, enabling the speaker and host association to present CDT Codes. The Code on Dental Procedures and Nomenclature is published in CDT 2018 Current Dental Terminology, Copyright 2018, American Dental Association (ADA) All rights reserved.

www.katrinasanders.com katrina@katrinasanders.com

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