D8000 – D8999 Orthodontics

Chapter 11.

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.

Key Definitions and Concepts

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

Limited orthodontic treatment could involve palatal expansion or be as simple singular tooth movement with a retainer. Typically, limited coding can be used to report treatment using simple appliances and simple movements that are directed at improving a specific problem for the patient.

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).

Diagnosis Codes – ICD-10-CM

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

Anomalies of tooth position

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

Q75.3

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

 

K05.20

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

S02.2XXA

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

S02.62XA

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 Scenarios

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.

Only gold members can continue reading. Log In or Register to continue

Dec 22, 2019 | Posted by in General Dentistry | Comments Off on D8000 – D8999 Orthodontics
Premium Wordpress Themes by UFO Themes