News

CDT Coding And The Nation-wide Opioid Crisis

CDT Coding And The Nation-wide Opioid Crisis
by Patti DiGangi, RDH, BS

The United States is in the throes of an opioid epidemic. The opioid crisis changes the need for diagnostic coding and increases the already important role of office managers. Most often, coding is left primarily to the business professionals in our practices. In a fast, moving, changing world, this can no longer be the case. Now more than ever, dentists and all clinicians must become more involved in coding – it has become a team sport.

Opioid Crisis and Dentistry
In 2016, opioids including prescription opioids, heroin and fentanyl killed more than 42,000 people - more than any year on record. The CDC reports show 40 percent of opioid deaths involved a prescription pain reliever. Opioid addiction impacts more than just the user; family members and close friends can be deeply impacted by the addiction from which their loved one is suffering.

While Dentistry can contribute to this problem, it also now has the opportunity to make a difference to help stem this crisis. There is legislative activity in many state capitals across the nation. The American Dental Education Association - October 2017 publication, offers a Summary of State Legislation and Regulations Addressing Prescription Drug and Opioid Abuse.

Lessons from Ohio

The state of Ohio has made changes of particular note to office managers. Dentists in Ohio are now required to adhere to their Board of Pharmacy rules for what constitutes a valid prescription. What makes this different is the requirement for controlled substances to include a diagnosis code effective for all opioid prescriptions as of 12/29/17 and all other controlled substances by 6/1/18. Dentistry has yet to implement the nation-wide use of diagnosis codes. This brings the question of how a dentist can comply. Diagnostic coding is no longer ‘if,” as this shows but has become, ‘when.’ Forward-thinking office managers are already putting this rule in place with their dentist and teams to prepare for the future.

Diagnosis Code Use Now

As already noted, at this time, dentistry is not required to use diagnosis codes. Smart practices, however, are already doing so. This is not limited to medical cross-coding. Both ADA claim forms and HIPAA standard electronic claim transactions are able to report up to four diagnosis codes per dental procedure in Box 34 A. This information may affect how a claim is paid when specific dental procedures minimize the risk associated with the patients oral and systemic health condition.

Continuous coding training for the entire dental team is needed. The CDT 2018 Companion from the ADA continues to be revised and reorganized, each chapter is written by dental industry leaders, including coding consultants, insurance administrators and practicing dentists, who guide the reader step-by-step through key coding concepts, scenarios and Q&A. Important to this discussion of diagnostic coding, CDT 2018 Companion include tables linking CDT Codes with applicable ICD-10 Diagnosis Codes.

Diagnostic Codes on Prescriptions

Dentists by virtue of their clinical education, along with experience and professional ethics, are responsible for the diagnosis. As such, the dentist is also obligated to select the appropriate diagnosis for patient record and claim submission. AND now in the case of Ohio, on prescriptions.
Codes are important for more than submitting for 3rd party reimbursement. Federal HIPAA law requires the use of CDT Code in electronic health care transactions. Using CDT codes can help to stem the opioid crisis tide.
There are no CDT codes for writing prescriptions. The CDT code required for this purpose is the treatment code. For example, a prescription for opioids is written after:

• D7410 extraction, erupted tooth or exposed root
• D9110 palliative (emergency) treatment of dental pain
• D3310 endodontic therapy, anterior tooth

to explain how and where the CDT number is placed. Though CDT coding is only required on prescriptions in Ohio at this time, it’s good practice everywhere.

Accurate Coding

No longer just a matter for 3rd party reimbursement, CDT coding now plays another role and its accuracy has never been more important as it is now and will be in the future. Coding, fees and coverage are all mixed up together in our thinking but Office Managers can lead the way to help the dentist and the team understand and separate each of these related terms.

The opioid epidemic is a national public health emergency. Dentistry has a role. Actions taken now can help prevent this crisis from lasting into the next generation. It may be going too far to say, dental codes can save lives….or it may not.



Patti DiGangi, RDH, BS believes dentistry is no longer just about fixing teeth. Dentistry IS oral medicine. She works with dental professionals to demystify coding through her workshops, webinars and keynote speeches.

Patti also shares her insights and expertise through her DentalCodeology books, which are dedicated to helping dentistry provide more efficient, cost-effective, evidence-based and value-based clinical care.

As a result of Patti’s work, dental professionals are coding more accurately, increasing practice profitability, and improving the oral-systemic health of their patients.