In the fall 2017 edition of The Beacon, the American Association of Dental Consultant’s quarterly newsletter, an endodontist, William Pack, D.D.S., M.S.D., wrote an article titled “An Endodontist’s Admonition for Submitting Code D3331.” The codes D3331 (treatment of root canal obstruction) and D2955 (post removal) are commonly denied for being part of the primary procedure, especially endodontic retreatment claims.
Dr. Pack supported his opinion on the approval of submitted code D3331 by writing that when canal obstructions are confronted, operating costs increase. He stated that these cases often require “several extra packs of hand files” and can require “specialized instruments” such as ultrasonic handpieces and file retrieval systems. Admittedly, a modern well-equipped office providing endodontic treatment will have many adjunctive types of equipment adding to the basic expenses and overhead of practicing. Using extra hand files for such cases does not merit the submission of accompanying high fees, commonly hundreds of dollars.
Another article of significance was written by an endodontist, Ali Behnia, D.M.D., M.S., in the June 24, 2016, American Association of Endodontists’ (AAE) monthly newsletter, The Communique. The article was posted in the Advocacy Practice Management section and titled “CDT Codes D3331 and D2955: Use, Don’t Abuse.”
Dr. Behnia, who was the chairperson of the AAE’s Practice Affairs Committee, discussed a meeting which he attended with several prominent AAE officers and 20 dental directors representing large dental insurers. The main theme taken away from the meeting was that the insurers consider these two codes to be overused and abused. He stated that one dental director referred to D3331, only partly in jest, as a “revenue enhancement code.”
Both Dr. Pack and Dr. Behnia agreed on one important conclusion: providers must use all available modalities to thoroughly document their treatments. These can include clear, properly angled radiographic images, CBCT images and well-illuminated, possibly magnified intra-oral photographs. Along with the images, detailed narrative and chart notes should be submitted explaining and describing all specialized instruments used. These types of requirements also apply to post removal. This procedure can vary between using an ultra-sonic handpiece on a prefabricated post which pops out of the canal after a few seconds of vibration to drilling through a solid cast gold core. These procedures are often tedious, so, if extra appointment times are needed, that is significant.
In closing, with adequate documentation, consultants can fairly adjudicate and decide whether to approve these codes of treatment.
