D3000 – D3999 Endodontics
By Kenneth Wiltbank, D.D.S.
Endodontics utilizes the 3000 section of the CDT Code. These codes concern procedures related to maintenance of the pulp, regeneration of the pulp and, of course, removal of the pulp and obturating the space where it previously existed. There are surgical codes that pertain to endodontics, including periradicular surgeries as well as use of bone grafting and bone regenerating materials.
Some of the main challenges and questions that are typical to Endodontics involve how to code for procedures when they are done in more than one appointment. Other frequently asked questions deal with what things are considered a part of the root canal and what things can be coded separately. For example, when to use codes D3331 (root canal obstruction), or D9630 (drugs dispensed in the office) for special endodontic irrigation at home, in conjunction with a root canal code in the claim. Another example would be the question of which radiographs are a part of the root canal procedure and which can be separately coded. Separately, CDT Code entries for procedures that involve pulpal regeneration are clear, but they are less commonly used and can be confusing unless the process has been studied by the office coding specialist.
Root canal: This term is used both for the anatomical space where the pulp and blood vessels reside in a vital tooth, and to describe a procedure done to evacuate, clean and fill that same space with a dental material. Thus, it has two different definitions as a noun, and is also occasionally used as a verb: “to root canal.” Some teeth have a single root canal space, while others have several root canal spaces. A root canal procedure for a given tooth, treats all of the root canal spaces in that tooth.
Pulpectomy: The process wherein a dentist removes the nerve entirely from the root canal space. This process varies in difficulty, tooth by tooth.
Pulpotomy: The process wherein a dentist removes the pulp from the pulp chamber but not the root canal spaces in a tooth. Can be used as a temporary solution to relieve symptoms, or as a permanent solution for a tooth likely to be able to maintain vital pulp in its roots, despite impingement upon the pulp in the pulp chamber.
Irrigation: Part of the pulpectomy where a fluid is used to flush out the canal while cleaning the canal. A standard part of the root canal procedure.
Obturate: The process of filling the space where the nerve used to reside, with some type of dental material. This process must be complete in order to claim that the root canal is finished. After obturation, the tooth will still need final, coronal restoration.
Dental dam: A part of the root canal procedure wherein a tooth is isolated by clamping around it and placing a flexible, tight, rubber-like sheet that will keep the equipment and irrigants on the dentist’s side and a patient’s saliva on the other side, away from the pulp chamber that is being kept sterile. Dams are considered standard operating procedure per the American Association of Endodontist’s Position Statement entitled, “Dental Dams” found at:
There are some root canal treatments where extraordinary measures have to be taken to fit a dental dam over a tooth. In these cases dam placement is documented using CDT Code D3910 surgical procedure for isolation of tooth with rubber dam.
Pulpal regeneration: A procedure, likely to include multiple appointments, whose intention is to sterilize a root canal space, then encourage vital tissue to grow back into that canal space in an attempt to strengthen a weak tooth and regain vital tissue in the pulp canal space.
Apexification: A procedure traditionally used to treat similar types of teeth as pulpal regeneration. In these cases, multiple appointments are used in a tooth that became necrotic, to develop a “stop” at its root end, that can allow a better obturation of its root.
Apexogenesis: A procedure similar to pulpotomy, but often less aggressive. The purpose being, to allow pulp to continue to exist and thrive in the pulp chamber and root canal space below.
In CDT 2018 there were five changes made in the Endodontics category, all of which are related to vocabulary consistency across the code set. In Codes D3320, D3347, D3421 and D3426 the word “bicuspid” was changed in favor of the word “premolar”. Both words are often used in the U.S. during discussion among colleagues, but for the language of the codes, it was decided to go with the more regularly used and modern “premolar” over “bicuspid”. Code D3330 was changed by adding the word “tooth” after the word molar, similar to the other codes, to provide consistency with other codes in this same section.
These types of changes are consistent with Code Maintenance Committee’s attempts to make the CDT’s language consistent to help with communication and decrease confusion, as well as simply to make the set more logical and well thought through.
Technological improvements have occurred in endodontics over the years, and they have significantly improved dentists’ ability to save teeth that have endodontic needs. While many of these technological improvements have not changed the way that we name or code the procedures, there are some past noteworthy changes.
A separate series of codes for pulpal regeneration (D3355-D3357) was added in CDT 2014 to recognize that this is a distinct treatment modality. Before this action pulpal regeneration was coupled to apexification procedures and reported with those codes.
Concurrent changes in CDT 2013 enabled separate reporting of post removal (D2955) in the course of endodontic retreatment (D3346-D3348). The nomenclatures and descriptors, until then, precluded separate reporting. These changes recognized that post removal is not always a component of a retreatment procedure, and that when performed post removal can take as much as 30 minutes and incur the cost of an ultrasonic tip or two. The CDT 2013 changes also enabled more accurate documentation on a patient’s dental record.
The bone grafting codes (D3427-D3429) were added to Endodontics in CDT 2014 to help explain the reason why bone grafting was done. Before then the bone grafting codes in Periodontics were the only codes to use, which caused confusion. The confusion arose because bone grafting at the end of endodontic apical surgery was often misunderstood as there were no deep periodontal probing pockets, and no history of periodontal treatment. This often precluded timely processing of the grafting code.
The endodontic surgical procedure codes were reorganized in CDT 2014 to more easily distinguish between periradicular surgeries with apicoectomy from a periradicular surgery done on the external aspect of a root, without resection of the root itself.
Diagnosis Codes – ICD-10-CM
The CDT to ICD tables in Appendix 1 provide appropriate guidance on linkages between Endodontics procedure codes and diagnosis codes. This chapter contains supplemental information on this topic, when claims for endodontic services are submitted to a medical benefit plan.
Claims against medical benefit plans use the AMA’s CPT code set to report procedures, and the same ICD code set for diagnoses. There are two main situations in which endodontists would use CPT codes and corresponding ICD-10 codes:
• Trauma cases, where a medical insurance plan has been assigned to cover expenses of the accident
• When dental benefit plan provisions require surgical codes be submitted through medical insurance prior to being submitted for dental benefits
There are several CDT Codes used to document procedures delivered for an endodontic case that have comparable CPT codes:
• Diagnostics – D0140-D0171 correspond to CPT codes 99201-99204 for new patients, and 99212-99215 for established patients.
• Radiographs – D0220 and D0230 correspond to CPT codes 70300 and 70310, respectively.
• Endodontic procedures – D3000-D3999 correspond to the single CPT code 41899 that is defined as “unlisted procedure, dentoalveolar structure.”
CODING SCENARIO #1
Root Canal Started in Another State
A patient presents to a dental office having had a root canal started on a single rooted tooth #29 in another state while on vacation. The patient is not in any pain. An exam is performed and a diagnostic, preoperative radiograph is made and evaluated. The radiograph shows evidence of a large periapical radiolucency as well as radiopaque evidence that calcium hydroxide has likely been placed in the root canal space. A treatment plan is made so that the patient might have the root canal completed, a buildup is placed and a crown made.
At the appointment in which the root canal is intended to be completed, it is found that ninety minutes was insufficient to complete the case and as well, and surprisingly, a significant amount of purulent exudate came into the tooth from the periapical tissues. A second appointment was made.
During the second appointment, the root canal was completed to a good result and a buildup was placed. An intraoperative radiograph and two post-operative radiographs were made during this appointment. A crown preparation appointment was made.
What procedure codes would be used to document and report the services provided during each of the three encounters?
Visit #1 (patient presents)
D0140 limited exam – problem focused
D0220 intraoral – periapical first radiographic image
Visit #2 (root canal began, but not completed)
D3999 unspecified endodontic procedure, by report
Visit #3 (root canal completed and core buildup placed)
D3330 endodontic therapy, molar (excluding final restoration)
D2950 core buildup, including any pins when required
• No additional radiographs were billed after the preoperative, diagnostic radiograph
• The endodontic technologies that are used during the appointment are treated as a part of the root canal procedure itself.