D2000 – D2999 Restorative
By Ronald Riggins, D.M.D.
Introduction
Restorative codes represent the majority of dental procedures done in a general dental practice on a day-to-day basis. Selection of the applicable code, or codes, for restorative services is very straight forward when the user understands the CDT Code’s underlying organization and concepts.
There have been few recent changes in the CDT Code’s Restorative category. Those that have been made filled some gaps and provided additional clarity. In this chapter, some basic terms are defined, recent restorative code changes are discussed, use is illustrated in common coding scenarios, and it concludes with several FAQ.
Local anesthesia is usually considered to be part of the restorative procedure.
Direct Restorations
Amalgam restorations include the tooth preparation, all adhesives (including amalgam bonding agents), as well as liners and bases. If pins are used, they are reported separately using the applicable procedure code (see D2951).
The amalgam codes are used to report procedures performed on primary or permanent dentition, with no differentiation between anterior and posterior teeth.
Resin-based composite restorations include tooth preparation, acid etching, adhesives, liners and bases and curing of the material. If pins are used, they are reported separately (see D2951.)
The resin-based composite codes are used for reporting procedures performed on the primary or permanent dentition. However, unlike amalgam codes the resin-based codes differentiate between procedures performed on anterior and posterior dentition.
All glass ionomers, when used as restorations, are reported using the resin-based composite codes.
Indirect Restorations
Inlay restorations are intra-coronal restorations made outside the mouth. They conform to a prepared cavity and do not restore any cusp tips.
Onlay restorations are made outside the mouth. They cover one or more cusp tips and adjoining occlusal surfaces, but not the entire external surface.
Crown restorations are made outside the mouth. They cover all of the cusps on posterior teeth, extend beyond the height of contour on all covered surfaces and restore all four proximal surfaces.
¾ crown restorations are made outside the mouth. They cover all of the cusps on posterior teeth, extend beyond the height of contour on the covered surfaces and restore three of the four proximal surfaces.
This table was updated in CDT 2017 to clarify that “Facial” and “Labial” are synonymous when describing surfaces involved in a restoration.
|
Location |
Number of Surfaces |
Characteristics |
|
Anterior |
||
|
1 |
Placed on one of the following five surface classifications – Mesial, Distal, Incisal, Lingual, or Facial (or Labial) |
|
|
2 |
Placed, without interruption, on two of the five surface classifications – e.g., Mesial-Lingual |
|
|
3 |
Placed, without interruption, on three of the five surface classifications – e.g., Lingual-Mesial-Facial (or Labial) |
|
|
4 or more |
Placed, without interruption, on four or more of the five surface classifications – e.g., Mesial-Incisal-Lingual-Facial (or Labial) |
|
|
Posterior |
||
|
1 |
Placed on one of the following five surface classifications – Mesial, Distal, Occlusal, Lingual, or Buccal |
|
|
2 |
Placed, without interruption, on two of the five surface classifications – e.g., Mesial-Occlusal |
|
|
3 |
Placed, without interruption, on three of the five surface classifications – e.g., Lingual-Occlusal-Distal |
|
|
4 or more |
Placed, without interruption, on four or more of the five surface classifications – e.g., Mesial-Occlusal-Lingual-Distal |
Note: Tooth surfaces are reported on the HIPAA standard electronic dental transaction and the ADA Dental Claim Form using the letters in the following table.
|
Surface |
Code |
|
Buccal |
B |
|
Distal |
D |
|
Facial (or Labial) |
F |
|
Incisal |
I |
|
Lingual |
L |
|
Mesial |
M |
|
Occlusal |
O |
Restorative has one change for CDT 2018, the following nomenclature revision:
D2740 crown – porcelain/ceramic substrate
Removal of this word from the D2470 nomenclature brings consistency to the CDT Code, in particular with the entry “D2783 crown – ¾ porcelain/ceramic” that was added in CDT-3. That addition was effective January 1, 2000 and has continued unchanged since then.
There is no documentation that explains the inclusion of “substrate” in the D2740 nomenclature. This entry has been in the CDT Code since the first version was published in the Journal of the American Dental Association in 1969. The code and its nomenclature has continued without change in all subsequent versions, until now.
Other than CDT 2018’s single revision, there have been relatively few recent changes in the Restorative category. However, the few codes that have been added or revised have been a long time in the making. These new and revised codes have closed some gaps and provided clarity to the restorative codes.
D2799 provisional crown – further treatment or completion of diagnosis necessary prior to final impression
Not to be used as a temporary crown for a routine prosthetic restoration
This code was added to give the clinician a way to code for situation where the initial diagnosis is altered by what the clinician finds once the procedure has begun. Many times the clinical reality of the patient’s problem is different than what is ascertained by the patient history, exam, radiographs and other diagnostic findings.
D2940 protective restoration
Direct placement of a restorative material to protect tooth and/or tissue form. This procedure may be used to relieve pain, promote healing, or prevent further deterioration. Not to be used as a temporary crown for a routine prosthetic restoration.
D2921 reattachment of tooth fragment, incisal edge or cusp
This code was added because of the evolution of bonding technology allowing for a predictable reattachment of a tooth fragment. It is often possible and desirable to bond a fractured tooth fragment due to trauma, especially in pediatric patients.
D2949 restorative foundation for an indirect restoration
Placement of a restorative material to yield a more ideal form including elimination of undercuts.
This code was added to fill a CDT Code gap as there was no way to code for the placement of material to gain a more ideal form for indirect restorations. Previously, the clinician would have to choose between not coding for a procedure or coding for a core build up.
Diagnosis Codes – ICD-10-CM
The CDT to ICD tables in Appendix 1 provide appropriate guidance on linkages between Restorative procedure codes and diagnosis codes. This chapter does not contain supplemental information on this topic.
CODING SCENARIO #1
Fractured Tooth – After Hours Visit and the Final Restoration
The patient presents with a broken front tooth on Saturday, a day the office was usually closed. On examination, tooth #8 appeared to have a fractured mesial-incisal angle and lost a mesial composite restoration, with no pain reported. The doctor removed enough tooth structure to fit and cement a polycarbonate crown. The patient was told that the tooth would need a porcelain-fused-to-metal crown (PFM), but this could be done at a scheduled appointment during regular office hours.
How could you code for this after hours visit?
D0140 limited oral evaluation – problem focused
D2799 provisional crown – further treatment or completion of diagnosis necessary prior to final impression
Note: This code is used instead of D2970 temporary crown (fractured tooth) because D2970 was deleted as of CDT 2016. The Code Maintenance Committee determined that the entry was limiting by specifying “fractured tooth” in the nomenclature, and there are other codes that more accurately describe the procedure and its intended outcome (i.e., D2799 provisional crown or D2940 protective restoration).
D9440 office visit – after regularly scheduled hours
Note: The after-hours office visit code (D9440) is from the Adjunctive Services section of the Code and can be reported in addition to the other services performed at that appointment. This service may not be covered or reimbursed by some dental benefits plans.
How would this visit during regular office hours be coded?
D2950 core buildup, including any pins, when required
Replacement of tooth structure that is more than simply filling undercuts is appropriately reported using the code for a core buildup (D2950). The retentive pin that was placed is included in the procedure documented with this code.
Note: D2950 would not be appropriate if the material is used only to eliminate undercuts or to yield a more ideal form for a subsequent indirect restoration. In this situation the procedure would be documented as “D2949 restorative foundation for an indirect restoration.”
D2752 crown – porcelain fused to noble metal
The code for a PFM utilizing a noble metal (D2752) rather than a high noble metal (D2750) was selected because the alloy used in the crown contains more than 25% but less than 60% noble metals.
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