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INTERIM BULLETIN 04/24/2020

Updated:
April 2020
Topic:
Coding

COVID19 - Charging Extra for Personal Protection Equipment

The American Dental Association (ADA) has recently released interim guidance for dental practices regarding the use of COVID-19-related Personal Protection Equipment (PPE) as outlined by the Centers for Disease Control (CDC). With the new CDC recommendations comes a rise in expenses for your dental practice. Historically, costs related to PPE and sterilization procedures have been considered inclusive of the procedurea practice business expense.

The ADA has asked payers to consider not bundling the fee for these additional PPE expenditures, and instead treating them as a non-covered service, billable to the patient. Most Preferred Provider Organization (PPO) contracts disallow (non-billable to the patient) charging the patient an additional fee related to PPE, sterilization, and any OSHA required procedures. Refer to your PPO Processing Policy Manual.

Billing and Documentation

The ADA has recommended reporting D1999—unspecified preventive procedure by report—as an interim solution to reporting the required additional PPE. As with all CDT codes that include “by report” in the nomenclature, a narrative is required. Remember, the narrative should be limited to 80 characters when entered in the remarks section of the 2019 ADA Dental Claim Form. The chart note should include the type of additional PPE used. D1999 should be reported on a per-visit basis. Stay tuned for further guidance from the ADA and possibly a code specific for PPE to be added to CDT soon!

Reimbursement

As previously stated, the ADA has reached out to payers asking them to increase reimbursement and/or allow a separate fee for PPE. A few payers are considering an interim reimbursement for a designated period, such as for two months. We expect there will be more payers implementing a similar interim provision. Check with your PPO payers for guidance often, as this is changing daily. If you are a Medicaid provider, contact your state Medicaid provider office for advice as to whether this charge will be allowed. We do not anticipate payers to allow reimbursement for D1999 permanently, only as it relates to this pandemic.

Source: https://success.ada.org/~/media/CPS/Files/COVID/ADA_Third_Party_Payer_Reimbursement_for_PPE.pdf?_ga=2.262131854.2036011925.1587677936-1796837210.1552659841.

© 2020 American Dental Support, LLC

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D6980

REVISED CODE

Fixed Partial Denture Repair

A single cast metal crown restoration that is retained, supported and stablized by an abutment on an implant; may be screw retained or cemented.

NOTE: May be orthodontic related