Dental offices and dental plan administrators like Delta Dental use a common language, the ADA’s CDT codes, to communicate with one another on claim forms, chart notes, narratives and during phone conversations. Sometimes the CDT code descriptors are vague or ambiguous and this can result in the misuse of certain codes. Delta Dental of Missouri surveyed its dental consultants to learn which codes are most often misused. The two most frequently misused codes are listed below with comments. Future editions of Consultant’s Corner will describe additional misused codes.
Code Descriptor
D7250 Removal of residual tooth roots (cutting procedure)
Includes cutting of soft tissue and bone, removal of tooth structure, and closure.
Comments: “Residual tooth roots” are root remnants remaining in the alveolar process after a prior incomplete extraction. For code D7250 to be benefitted, the pre-operative radiographic appearance of the residual root should be consistent with a prior incomplete extraction and bone should completely encase the root. The procedure to remove the root must include a surgical flap, removal of bone and tooth remnants and closure. If the coronal portion of a tooth is missing due to caries or fracture (rather than a prior incomplete extraction), the removal should be coded as a D7140 or D7210. The removal of the root portion of the tooth through elevation and forceps should be coded as a D7140 (extraction, erupted tooth or exposed root). If a flap, bone removal and/or root sectioning is required to remove the root, the correct code is D7210.
Code Descriptor
D2950 Core buildup, including any pins when indicated
Refers to building up of coronal structure when there is
insufficient retention for a separate extracoronal restorative
procedure.
A core buildup is not a filler to eliminate any undercut, box form, or concave irregularity in a preparation.
Comments: Code D2950 is only benefitted when additional axial wall height and/or width is required to provide appropriate resistance form and retention for an indirectly fabricated restoration. If there is sufficient existing axial wall structure to provide appropriate resistance form and retention, the D2950 will not be benefitted and the patient cannot be balance-billed. Delta Dental does not benefit core buildups when used with an inlay, onlay, 3/4 crown or to fill an endodontic access opening when there is sufficient existing axial wall structure to provide appropriate resistance form and retention. Code D2950 is frequently confused with code D2949 (restorative foundation for an indirect restoration – Placement of restorative material to yield a more ideal form, including elimination of undercuts). D2949 is the appropriate code when sufficient axial wall height and width exists but a restorative material is needed to fill in undercuts, box forms, or concavities created by previously-placed deep occlusal restorations. D2949 is considered to be inclusive to the indirect restoration by Delta Dental of Missouri and is not benefitted nor billable to the patient.
All codes and descriptors are from the ADA’s CDT 2019 Dental Procedure Codes guidebook.
