Are you using the correct codes for splinting on your dental claim form? Did you know that several codes related to splinting have been deleted and replaced?
This month we feature the newly updated and recently deleted ADA CDT codes for splinting procedures
Deleted codes
D4320: Provisional splinting, intracoronal
D4321: Provisional Splinting, extracoronal
New codes
D4322: Splint, intracoronal; natural teeth or prosthetic crowns
D4323: Splint, extracoronal; natural teeth or prosthetic crowns
The purpose of provisional splinting is to stabilize mobile (loose) teeth and maintain them in the position before periodontal surgery due to bone loss. The teeth are cleaned and isolated, no anesthesia is typically used, but in some cases the teeth will be cut and anesthesia must be used. There are different types of splinting materials, the most common being metal wire or braided fibers. The “wire” is then placed along the teeth and bonded and cured.
Although resin bonding will be used to attach the splint to the teeth, it is not advised to submit for reimbursement as individual composites.
There are many variables involved when it comes to dental insurance coverage and reimbursement:
Dental insurance companies will usually only cover “permanent” procedures, and according to insurance companies, a splint is a temporary prosthesis.
If bone loss is visible on x-rays, the dental insurance company may suggest that the treatment is unnecessary in order to avoid paying for it. The company may provide benefits toward a tooth extraction instead.
Submitting a clear narrative that explains the benefits of splinting and outlining the treatment plan with the desired prognosis can help facilitate approval in some cases.
Providing x-rays, narrative, recent periodontal charting, and photographs will ensure a smooth claims process.
It's very important to remember this: Even though the insurance company may not pay for a particular procedure, this doesn't mean that the insurance company’s decision is in the best interest of the patient.
Comments