D8000 – D8999 Orthodontics
By Stephen Robirds, D.D.S.
Introduction
The total number of codes in the Orthodontics category of service is fewer than most other categories. For example, in CDT 2018 there are 22 codes in Orthodontics and 83 in Restorative. The reason for this concise set of codes is that some aspects of an orthodontics case involve procedures (e.g., radiographs) that are documented and reported using CDT Codes found in other categories of service.
The purpose of an orthodontic procedure is to reposition teeth in a dental arch and influence skeletal and muscular changes in the oral and maxillofacial complex. This restores health, occlusion, esthetics, or any combination to an acceptable treatment result. Acceptability is to be determined by both the patient (or the patient’s parent or guardian) and the treating doctor.
To code for any of these procedures, dentists and their teams must know what they are trying to accomplish in the first place. What is the end result you desire? Are you just expanding a maxillary arch form or is this part of a broader plan to correct the bite and align the teeth? Is it your ultimate goal to simply close a diastema or close space to create an occlusion prior to orthognathic surgery?
In orthodontics, it is prudent to begin with the end in mind.
Primary Dentition: The stage during which the deciduous (or “baby”) teeth erupt and are present. Typically, orthodontic treatment does not begin prior to complete eruption of the deciduous dentition and the permanent first molars are usually in the process of erupting or have fully erupted. The age of a patient can vary based on development, but usually ranges from ages five to eight.
Transitional Dentition: The stage where the patient still has some deciduous teeth remaining and permanent teeth are emerging. The deciduous cuspids and molars are losing root structure and should be exfoliating during this stage. Age, again, can vary, but typically ranges from nine to twelve years old.
Adolescent Dentition: The stage where deciduous teeth are gone and permanent teeth are erupting or have fully erupted with the exception of the third molars. The patient is still in a growing phase, possibly pre-pubertal or in the process of puberty. Body changes at this time can be dramatic, including extensive growth of the oral-maxillofacial complex. Adolescent dentition typically occurs during ages twelve to fifteen, depending upon the sex of the patient as males and females do mature at different rates.
Adult Dentition: This final stage is the full permanent dentition with little or no patient growth remaining. Third molars, if present, are usually erupted unless there is lack of space for eruption or the teeth are malposed.
Limited Orthodontic Treatment: The category of orthodontic treatment that involves a specific, defined, and limited scope of treatment. An example would be a tooth in crossbite or one that needs guidance during eruption. Limited treatment may not necessarily involve the entire dentition and can be done at any of the stages of dental development.
Codes exist for each stage of development:
• D8010 for the primary dentition
• D8020 for the transitional dentition
• D8030 for the adolescent dentition
• D8040 for the permanent dentition
Interceptive Orthodontic Treatment: Treatment performed under this category should only be coded for treatment done during the primary dentition (D8050) or transitional dentition (D8060) stages of dental development.
The three main considerations for this type of treatment are as follows:
• Is there enough room for full eruption of the permanent dentition?
• Are there any concerns about the patient’s bite (malocclusion)?
• Can these concerns be improved or corrected with early intervention?
Diagnostic records are important, but the extent to which they are necessary to accurately diagnose the case can vary. Treatment modalities are likely to vary depending on the situation and severity, but often are appliances that don’t involve braces. A localized area on one of the arches, one entire arch or both arches may be involved. The idea behind interceptive treatment is to greatly improve issues in these earlier stages of development that simplify or possibly eliminate the need for comprehensive treatment later on. Typical examples may include palatal expansion, appliances to gain or maintain space, or appliances designed to moderate or guide skeletal growth of an individual. Examples of this type of treatment may involve headgear, a Herbst appliance or other growth modifiers.
Comprehensive Orthodontic Treatment: This is the most involved treatment care an orthodontist can provide. It includes careful diagnosis and treatment planning including detailed orthodontic records. It involves correction of the patient’s dentofacial issues including any skeletal, muscular, and/or dental disharmony issues. Comprehensive treatment can be provided during the transitional (D8070), adolescent (D8080), or permanent (D8090) dentition stage of dental development. Treatment may include a multi-disciplinary approach and involve treatment or consultation with other dental providers such as oral surgeons and periodontists. Treatment may also include medical specialty providers such as speech therapists, ENT physicians, etc. This is not to be confused with medically necessary orthodontic cases which are in a completely separate category. MNOC (Medically Necessary Orthodontic Care) cases, according to the Affordable Care Act, are reported using medical diagnostic coding based on the severity of the case, the age of the patient (under 19 years of age), and medical involvement to correct the patient’s overriding health issues.
Changes to This Category
The following code, for removal of fixed orthodontic appliances, was added in CDT 2018:
D8695 removal of fixed orthodontic appliance for reasons other than completion of treatment
This code will be used to report removal of appliances for a variety of circumstances other than the end of active treatment. Patients may request removal of the appliances in order to undergo a procedure such as an MRI, or may request removal for esthetic reasons such as participation in a wedding, etc.
Removal of appliances and placement of retainers at the conclusion of active treatment should be reported using D8680 orthodontic retention (removal of appliances, construction and placement of retainer(s).
The CDT to ICD tables in Appendix 1 provide appropriate guidance on linkages between often used Orthodontics procedure codes, and diagnosis codes. There are additional ICD-10-CM codes that may be applicable in some situations, or for procedures not listed. These additional codes are in the following table and are grouped by Term, Condition or Anatomy.
|
Term/Condition/Anatomy |
Code |
Definition |
|
Orthodontic exam and evaluation |
Z01.89 |
Encounter for other specified special examinations |
|
Pain |
||
|
G24.3 |
Spasmodic torticollis |
|
|
G24.4 |
Idiopathic Orofacial dystonia (Orofacial dyskinesia) |
|
|
G44.1 |
Vascular headache, not elsewhere classified |
|
|
G44.201 |
Tension-type headache, unspecified, intractable |
|
|
G44.209 |
Tension-type headache, unspecified., not intractable |
|
|
G44.211 |
Episodic tension-type headache, intractable |
|
|
G44.219 |
Episodic tension-type headache, not intractable |
|
|
G44.221 |
Chronic tension-type headache, intractable |
|
|
G44.229 |
Chronic tension-type headache, not intractable |
|
|
G50.0 |
Trigeminal neuralgia |
|
|
G50.1 |
Atypical face pain |
|
|
H57.10 |
Ocular pain, unspecified eye |
|
|
H57.11 |
Ocular pain, right eye |
|
|
H57.12 |
Ocular pain, left eye |
|
|
H57.13 |
Ocular pain, bilateral |
|
|
M26.62 |
Arthralgia of the temporomandibular joint |
|
|
M54.2 |
Cervicalgia |
|
|
M79.1 |
Myalgia |
|
|
M79.2 |
Neuralgia and neuritis, unspecified |
|
|
Migraine – Always check with patient’s primary care provider for which migraine code applies. |
||
|
G43.001 |
Migraine without aura, not intractable, with status migrainosus |
|
|
G43.009 |
Migraine without aura, not intractable, without status migrainosus |
|
|
G43.011 |
Migraine without aura, intractable, with status migrainosus |
|
|
G43.019 |
Migraine without aura, intractable, without status migrainosus |
|
|
G43.101 |
Migraine with aura, not intractable, with status migrainosus |
|
|
G43.109 |
Migraine with aura, not intractable, without status migrainosus |
|
|
G43.111 |
Migraine with aura, not intractable, with status migrainosus |
|
|
G43.119 |
Migraine with aura, intractable, without status migrainosus |
|
|
G43.701 |
Chronic migraine without aura, not intractable, with status migrainosus |
|
|
G43.719 |
Chronic migraine without aura, not intractable, without status migrainosus |
|
|
G43.801 |
Other migraine, not intractable, with status migrainosus |
|
|
G43.809 |
Other migraine, not intractable, without status migrainosus |
|
|
G43.811 |
Other migraine, intractable, with status migrainosus |
|
|
G43.819 |
Other migraine, intractable, without status migrainosus |
|
|
G44.1 |
Vascular headache, not elsewhere classified |
|
|
Sleep Apnea |
||
|
G47.30 |
Sleep Apnea, unspecified |
|
|
G47.31 |
Primary central sleep apnea |
|
|
G47.33 |
Obstructive sleep apnea |
|
|
G47.34 |
Idiopathic sleep related nonobstructive alveolar hypoventilation |
|
|
G47.35 |
Congenital central alveolar hypoventilation Syndrome |
|
|
G47.39 |
Other sleep apnea |
|
|
G47.63 |
Sleep related bruxism |
|
|
G47.8 |
Other sleep disorders |
|
|
G47.9 |
Sleep disorder, unspecified |
|
|
Nerve Disorders |
||
|
G50.8 |
Other disorders of trigeminal nerve |
|
|
G50.9 |
Disorder of trigeminal nerve, unspecified |
|
|
G51.8 |
Other disorders of facial nerve |
|
|
G51.9 |
Disorder of facial nerve, unspecified |
|
|
G52.1 |
Disorders of glossopharyngeal nerve |
|
|
Disorders of the Ears |
||
|
H92.01 |
Otalgia, right ear |
|
|
H92.02 |
Otalgia, left ear |
|
|
H92.03 |
Otalgia, bilateral |
|
|
H92.09 |
Otalgia, unspecified ear |
|
|
H93.11 |
Tinnitus, right ear |
|
|
H93.12 |
Tinnitus, left ear |
|
|
H93.13 |
Tinnitus, bilateral |
|
|
H93.19 |
Tinnitus, unspecified ear |
|
|
Larynx |
J38.5 |
Laryngeal spasm |
|
Anomalies of jaw-cranial base relationship |
||
|
M26.10 |
Unspecified anomaly of jaw-cranial base relationship |
|
|
M26.11 |
Maxillary asymmetry |
|
|
M26.12 |
Other jaw asymmetry |
|
|
M26.19 |
Other specified anomalies of jaw-cranial base relationship |
|
|
Anomalies of dental arch relationship |
||
|
M26.20 |
Unspecified anomaly of dental arch relationship |
|
|
M26.211 |
Malocclusion, Angle’s class I |
|
|
M26.212 |
Malocclusion, Angle’s class II |
|
|
M26.213 |
Malocclusion, Angle’s class III |
|
|
M26.219 |
Malocclusion, Angle’s class, unspecified |
|
|
M26.220 |
Open anterior occlusal relationship (anterior openbite) |
|
|
M26.221 |
Open posterior occlusal relationship (posterior openbite) |
|
|
M26.23 |
Excessive horizontal overlap (overjet) |
|
|
M26.24 |
Reverse articulation, crossbite (anterior or posterior) |
|
|
M26.25 |
Anomalies of interarch distance |
|
|
M26.29 |
Other anomalies of dental arch relationship Midline deviation of dental arch Overbite (excessive) deep, horizontal, or vertical Posterior lingual occlusion of mandibular. teeth |
|
M26.30
Unspecified anomaly of tooth position of fully erupted tooth or teeth
M26.31
Crowding of fully erupted teeth
M26.32
Excessive spacing of fully erupted teeth (diastema)
M26.33
Horizontal displacement of fully erupted tooth or teeth
M26.34
Vertical displacement of fully erupted tooth or teeth
M26.35
Rotation of fully erupted tooth or teeth
M26.36
Insufficient interocclusal distance of fully erupted teeth (ridge)
M26.37
Excessive interocclusal distance of fully erupted teeth
M26.39
Other anomalies of tooth position of fully erupted tooth or teeth
Other congenital malformations of skull and face bones
Q18.9
Congenital malformation of face and neck, unspecified
Q35.1
Cleft hard palate
Q35.3
Cleft soft palate
Q35.5
Cleft hard palate with cleft soft palate
Q35.9
Cleft palate, unspecified
Q37.0
Cleft hard palate with bilateral cleft lip
Q37.1
Cleft hard palate with unilateral cleft lip
Q37.2
Cleft soft palate with bilateral cleft lip
Q37.3
Cleft soft palate with unilateral cleft lip
Q37.4
Cleft hard and soft palate with bilateral cleft lip
Q37.5
Cleft hard and soft palate with unilateral cleft lip
Q37.8
Unspecified cleft palate with bilateral cleft lip
Q37.9
Unspecified cleft palate with unilateral cleft lip
Q38.5
Congenital malformations of palate, not elsewhere classified
Q38.6
Other congenital malformations of mouth
Q67.0
Congenital facial asymmetry
Q67.4
Other congenital deformities of skull, face, and jaw
Q74.0
Cleidocranial dysostosis/Oculoauricular Dysplasia/OAV
Q75.0
Craniosynostosis, Pierre Robin Sequence
Q75.1
Craniofacial dysostosis (Crouzon’s Syndrome)
Q75.2
Hypertelorism
Macrocephaly
Q75.4
Mandibulofacial dysostosis Treacher Collins Syndrome
Q75.5
Oculomandibular dysostosis
Q75.8
Other specified congenital malformations of skull and face bones
Q75.9
Congenital malformation of skull and face bones, unspecified
Other specified congenital malformation syndromes affecting multiple systems
Q87.0
Congenital malformation syndromes predominately affecting multiple systems Apert’s Syndrome (Acrocephalosyndactyly) Pfeiffer Syndrome (Acrocephalosyndactyly)
Q87.1
Noonan Syndrome
Turner’s Syndrome
Q96.0
Karyotype 45.X
Q96.1
Karyotype 46.X iso (Xq)
Q96.2
Karyotype 46, X with abnormal sex chromosome, except iso (Xq)
Q96.3
Mosaicism, 45,X/46, XX or XY
Q96.4
Mosaicism, 45, X/other cell line(s) with abnormal sex chromosomes
Q96.8
Other variants of Turner’s Syndrome
Q96.9
Turner’s Syndrome, unspecified
Dislocation of jaw
S03.0XXA
Dislocation of jaw, initial encounter
S03.0XXD
Dislocation of jaw, subsequent encounter
S03.0XXS
Dislocation of jaw, sequel
Strains and sprains
S03.4XXA
Sprain of jaw, initial encounter
S03.4XXD
Sprain of jaw, subsequent encounter
S03.4XXS
Sprain of jaw, sequela
Miscellaneous
E22.0
Acromegaly and pituitary gigantism
E23.0
Hypopituitarism (growth hormone deficiency)
G25.3
Myoclonus
K14.6
Glossodynia
M32.10
Systemic lupus erythematosus, organ or system involvement unspecified
M45.9
Ankylosing spondylitis of unspecified sites in spine
M43.6
Torticollis
R42
Dizziness, (light-headedness)
Diseases of Oral Cavity and Sinuses
K00.0
Anodontia (missing teeth) (Oligodontia)
K00.1
Hyperdontia (supernumerary teeth)
K00.2
Abnormalities of size and form
K00.3
Mottled teeth
K00.4
Disturbances of tooth formation
K00.5
Hereditary disturbances in tooth structure, not elsewhere classified
K00.6
Disturbance of tooth eruption
K00.8
Other specified disorder of tooth development and eruption
K00.9
Unspecified disorder of tooth development and eruption
K01.1
Impacted teeth
K02.51
Dental caries on pit and fissure surface limited to enamel
K02.52
Dental caries on pit and fissure surface penetrating into dentin
K02.53
Dental caries on pit and fissure surface penetrating into pulp
K02.61
Dental caries on smooth surface limited to enamel
K02.62
Dental caries on smooth surface penetrating into dentin
K02.63
Dental caries on smooth surface penetrating into pulp
K02.7
Dental root caries
K02.9
Dental caries, unspecified
K03.5
Ankylosis of teeth
K03.4
Hypercementosis
K03.5
Ankylosis of teeth
K03.9
Other specified diseases of hard tissues of teeth
K05.00
Acute gingivitis, plaque induced
K05.01
Acute gingivitis, non-plaque induced
K05.10
Chronic gingivitis, plaque induced
K05.11
Chronic gingivitis, non-plaque induced
Aggressive gingivitis, plaque induced
K05.21
Aggressive gingivitis, non-plaque induced
K05.22
Aggressive gingivitis, generalized
K05.30
Chronic periodontitis, unspecified
K05.31
Chronic periodontitis, localized
K05.32
Chronic periodontitis, generalized
K05.4
Periodontitis, juvenile periodontitis
K05.5
Other periodontal diseases
K05.6
Periodontal diseases, unspecified
K06.0
Gingival recession
K06.1
Gingival enlargement
K06.9
Disorder of gingiva and edentulous alveolar ridge, unspecified
Loss of Teeth
K08.0
Exfoliation of teeth due to systemic causes
K08.401
Partial loss of teeth, unspecified cause, class I
K08.402
Partial loss of teeth, unspecified cause, class II
K08.403
Partial loss of teeth, unspecified cause, class III
K08.404
Partial loss of teeth, unspecified cause, class IV
K08.409
Partial loss of teeth, unspecified cause, unspecified class
K08.411
Partial loss of teeth, due to trauma, class I
K08.412
Partial loss of teeth, due to trauma, class II
K08.413
Partial loss of teeth, due to trauma, class III
K08.414
Partial loss of teeth, due to trauma, class IV
K08.419
Partial loss of teeth, due to trauma, unspecified class
K08.211
Partial loss of teeth, due to periodontal disease, class I
K08.422
Partial loss of teeth, due to periodontal disease, class II
K08.423
Partial loss of teeth, due to periodontal disease, class III
K08.424
Partial loss of teeth, due to periodontal disease, Class IV
K08.429
Partial loss of teeth, due to periodontal disease, Unspecified class
K08.431
Partial loss of teeth, due to caries, class I
K08.432
Partial loss of teeth, due to caries, class II
K08.433
Partial loss of teeth, due to caries, class III
K08.434
Partial loss of teeth, due to caries, class IV
K08.439
Partial loss of teeth, due to caries, unspecified class
Major anomalies of jaw size
M26.00
Unspecified anomaly of jaw size
M26.01
Maxillary hyperplasia
M26.02
Maxillary hypoplasia
M26.03
Mandibular hyperplasia
M26.04
Mandibular hypoplasia
M26.05
Macrogenia
M26.06
Microgenia
M26.07
Excessive tuberosity of jaw (entire maxillary tuberosity)
M26.09
Other specified anomalies of jaw size
Dentofacial functional abnormalities
M26.50
Dentofacial functional abnormalities, unspecified
M26.51
Abnormal jaw closure
M26.52
Limited mandibular range of motion
M26.53
Deviation in opening and closing mandible
M26.54
Insufficient anterior guidance
M26.55
Centric occlusion maximum intercuspation discrepancy
M26.56
Non-working side interference
M26.57
Lack of posterior occlusal support
M26.59
Other dentofacial functional abnormalities
Temporomandibular joint disorders
M26.60
Temporomandibular joint disorder, unspecified
M26.61
Adhesions and ankylosis of temporomandibular joint
M26.62
Arthralgia of temporomandibular joint
M26.63
Articular disc disorder of temporomandibular joint
M26.69
Other specified disorders of temporomandibular joint
Dental alveolar anomalies
M26.70
Unspecified alveolar anomaly
M26.71
Alveolar maxillary hyperplasia
M26.72
Alveolar mandibular hyperplasia
M26.73
Alveolar maxillary hypoplasia
M26.74
Alveolar mandibular hypoplasia
M26.79
Other specified alveolar anomalies
M26.81
Anterior soft tissue impingement
M26.82
Posterior soft tissue impingement
M26.89
Other dentofacial anomalies
M26.9
Dentofacial anomaly, unspecified
Other diseases/disorders of jaws
M27.0
Developmental disorders of jaws
M27.2
Inflammatory conditions of jaws
M27.8
Other specified diseases of jaws
M27.9
Diseases of jaw, unspecified
Down’s Syndrome
Q90 codes
Contact patient’s primary care provider to determine the correct code
Arthritis and other diseases
M06.9
Rheumatoid arthritis, unspecified
M08.00
Juvenile rheumatoid arthritis of unspecified site
A69.20
Lyme disease, unspecified
L40.52
Psoriatric arthritis mutilans
L40.54
Psoriatic juvenile arthropathy
L40.59
Other psoriatic arthropathy
Disorders of Synovium, Tendon, Bursa
M65.9
Synovitis and tenosynovitis, unspecified
Disorders of Muscle, Ligament, Fascia, Soft Tissue
M24.20
Disorder of ligament, unspecified site
M35.7
Hypermobility syndrome
M60.9
Myositis, unspecified
M62.40
Contracture of muscle, unspecified site
M62.81
Muscle weakness (generalized)
M62.838
Other muscle spasm
M79.1
Myalgia
Fractures
Last character legend:
A = initial encounter
D = subsequent encounter
S = sequela
G = subsequent encounter for fracture with delayed healing
K = subsequent encounter with nonunion
A fracture not indicated in the patient record as open or closed should be coded to closed
Fracture of nasal bones, initial encounter for closed fracture
S02.2XXB
Fracture of nasal bones, initial encounter for open fracture
S02.400A
Malar fracture unspecified, initial encounter for closed fracture
S02.400B
Malar fracture, unspecified, initial encounter for open fracture
S02.401A
Maxillary fracture, unspecified, initial encounter for closed fracture
S02.401B
Maxillary fracture, unspecified, initial encounter for open fracture
S02.402A
Fracture of zygoma bones, unspecified, initial encounter for closed fracture
S02.402B
Fracture of zygoma bones, unspecified, initial encounter for open fracture
S02.411A
LaForte I fracture, initial encounter for closed fracture
S02.411B
LaForte I fracture, initial encounter for open fracture
S02.412A
LaForte II fracture, initial encounter for closed fracture
S02.412B
LaForte II fracture, initial encounter for open fracture
S02.413A
LaForte III fracture, initial encounter for closed fracture
S02.413B
LaForte III fracture, initial encounter for open fracture
S02.42XA
Fracture of alveolus of maxilla, initial encounter for closed fracture
S02.42XB
Fracture of alveolus of maxilla, initial encounter for open fracture
S02.600A
Fracture of unspecified part of body of mandible, initial encounter, closed
S02.600B
Fracture of unspecified part of body of mandible, initial encounter, open
S02.609A
Fracture of mandible, unspecified, initial encounter, closed
S02.609B
Fracture of mandible, unspecified, initial encounter, open
S02.61XA
Fracture of condylar process of mandible, initial encounter for closed fracture
S02.61XB
Fracture of condylar process of mandible, initial encounter for open fracture
Fracture of subcondylar process of mandible, initial encounter for closed fracture
S02.62XB
Fracture of subcondylar process of mandible, initial encounter for open fracture
S02.63XA
Fracture of coronoid process of mandible, initial encounter for closed fracture
S02.63XB
Fracture of coronoid process of mandible, initial encounter for open fracture
S02.64XA
Fracture of ramus of mandible, initial encounter for closed fracture
S02.64XB
Fracture of ramus of mandible, initial encounter for open fracture
S02.65XA
Fracture of angle of mandible, initial encounter for closed fracture
S02.65XB
Fracture of angle of mandible, initial encounter for open fracture
S02.66XA
Fracture of symphysis of mandible, initial encounter for closed fracture
S02.66XB
Fracture of symphysis of mandible, initial encounter for open fracture
S02.67XA
Fracture of alveolus of mandible, initial encounter for closed fracture
S02.67XB
Fracture of alveolus of mandible, initial encounter for open fracture
S02.69XB
Fracture of mandible of other specified site, initial encounter for open fracture
S02.8XXA
Fracture of other specified skull bones, initial encounter for closed fracture
S02.8XXB
Fracture of other specified skull bones, initial encounter for open fracture
S02.91XA
Fracture of unspecified skull and facial bones, initial encounter, closed
S02.91XB
Fracture of unspecified skull and facial bones, initial encounter, open
S02.92XA
Unspecified fracture of facial bones, initial encounter, closed
S02.92XB
Unspecified fracture of facial bones, initial encounter, open
CODING SCENARIO #1
Class II Malocclusion and Severe Crowding
A 12-year-old patient presents with a Class II malocclusion and severe crowding. The patient just lost her last deciduous tooth. Parents want the teeth straightened and bite corrected. The case has been diagnosed and treatment planned for full upper and lower braces and extraction of all four first bicuspids.
How would you code this procedure?
This case would be coded as D8080 comprehensive orthodontic treatment of the adolescent dentition because the patient is still experiencing erupting teeth and growth.
Stay updated, free dental videos. Join our Telegram channel
VIDEdental - Online dental courses
