Prophylaxis Definition Restored in CDT-4
The American Dental Hygienists' Association (ADHA) worked to raise awareness that an insurance code change made earlier this year could pose a hazard to the public. The American Dental Association (ADA) Code Revision Committee has now reversed a change made to the prophylaxis definition in Current Dental Terminology (CDT)-4, which made it possible to define the procedure as polishing alone.
In CDT-4, which went into effect January 1, 2003, the procedure code for a prophylaxis, 01110, was redefined as"scaling and/or polishing procedures to remove coronal plaque, calculus, and stains." However, during its first meeting held to consider revision requests on February 14, CRC voted unanimously (10-0) to remove the "/or" change from the definition, thereby restoring the CDT-4 wording to that used in CDT-3, which reads "scaling and polishing."
ADHA efforts to have the inaccurate definition corrected began immediately after CDT-4 was made public in October 2002 and later included the January 2003 Access feature story examining specific problems the change would precipitate. ADHA also sent a letter to ADA explaining its objections to the change along with a national campaign of letters sent to other oral health organizations, state dental boards, dental hygienists serving on state boards, state consumer protection agencies, and all ADHA constituent leaders.
ADA's executive director, James B. Bramson, DDS, replied to ADHA's letter: "The CRC acknowledged that there is a difference between the code's descriptor and the definition of prophylaxis in the CDT-4 glossary, and the apparent misinterpretation of the descriptor to mean that a prophylaxis can consist solely of polishing without scaling. Such was not the intent when the descriptor was revised, as the change to '...scaling and/or polishing...' was intended only to accommodate patients whose needs at the particular time of service did not include a scaling."
ADHA staff members attending the February CRC meeting were pleased with how well ADHA's concerns were received and the swift action CRC took to remove the "/or" wording from the prophylaxis definition in CDT-4.
Among the CDT codes-the recognized standard descriptions of services used throughout the United States by private insurers-01110 is the second most submitted claim, and any change to its description could have had widespread repercussions.
Had the change in definition not been reversed, offices may have adopted a practice of performing only a polishing (an aesthetic procedure), but billing for a full prophylaxis, thereby compromising the standard of patient care by denying patients the therapeutic benefits of a complete prophylaxis. In fact, after being contacted by ADHA about the 01110 change, some state dental boards took measures to place the issue on their agendas for upcoming board meetings.
From a scope-of-practice point-of-view, since 31 states now allow dental assistants to perform polishing, the change also could have seriously eroded the professional responsibilities of dental hygienists. ADHA's position on polishing is that only a licensed dental hygienist or dentist is qualified to determine the need for polishing procedures, and that polishing should be performed only as needed and not be considered a routine procedure.
ADA's Branson also acknowledged "ADHA's intent to take advantage of the process that has been established to facilitate requests to change the Code from any member of the dental community." Branson assured ADHA, "All such requests will be presented for full consideration and discussion by CRC."
- Paul Palmer