September/October 2004 1

CDT 2005 Comes Alive…CDT 2005, effective January 1, 2005, brings important changes of which every OMS must be aware. As we have advised inearlier issues of the AAOMS Today and AAOMS Advocacy E-Newsletter, CMS has eliminated grace periods for the use ofdiscontinued ICD-9, CPT and HCPCS codes as of October 1 for ICD-9 and as of January 1 for CPT and HCPCS. As CDTcodes are also contained within the HCPCS code set and sometimes preferred by medical carriers including Medicare, it isalso advisable to immediately begin using the new D codes for all dates of service beginning January 1, 2005. Changes inCDT 2005 include 39 new codes, 47 revisions, and 3 deletions. Changes specific to the oral and maxillofacial surgery chapterof the manual consist of 8 new codes, 11 revisions (including one to the subcategory heading), and 1 deletion for a total of 20changes. Read on for an explanation of these and others potentially relevant to the specialty…

ADDITIONS

D6190 radiographic/surgical implant index, by reportAn appliance, designed to relate osteotomy orfixture position to existing anatomic structures, tobe utilized during radiographic exposure fortreatment planning and/or during osteotomycreation for fixture installation.

D7283 placement of device to facilitate eruption ofimpacted toothPlacement of an orthodontic bracket, band or otherdevice on an unerupted tooth, after its exposure, toaid in its eruption. Report the surgical exposureseparately using D7280.

D7288 brush biopsy — transepithelial sample collectionFor collection of oral disaggregated transepithelialcells via rotational brushing of the oral mucosa.

D7311 alveoloplasty in conjunction with extractions — oneto three teeth or tooth spaces, per quadrantThe alveoloplasty is distinct (separate procedure)from extractions and/or surgical extractions.

D7321 alveoloplasty not in conjunction with extractions —one to three teeth or tooth spaces, per quadrant

D7511 incision and drainage of abscess — intraoral softtissue — complicated (includes drainage of multiplefascial spaces) Incision is made intraorally and dissection isextended into adjacent fascial space(s) to provideadequate drainage of abscess/cellulitis.

D7521 incision and drainage of abscess — extraoral softtissue — complicated (includes drainage of multiplefascial spaces)Incision is made extraorally and dissection isextended into adjacent fascial space(s) to provideadequate drainage of abscess/cellulitis.

D7953 bone replacement graft for ridge preservation — persiteOsseous autograft, allograft or non-osseous graft isplaced in an extraction site to preserve ridgeintegrity (e.g., clinically indicated in preparation forimplant reconstruction or where alveolar contour iscritical to planned prosthetic reconstruction).Membrane, if used should be reported separately.

D7963 frenuloplastyExcision of frenum with accompanying excision orrepositioning of aberrant muscle and z-plasty orother local flap closure.

D9942 repair and/or reline of occlusal guard

REVISIONS

D0150 comprehensive oral evaluation — new orestablished patientThis applies to new patients; established patientswho report a significant change in health conditionsor other unusual circumstances; or establishedpatients who have been absent from activetreatment for three or more years. It is a thoroughevaluation and recording of the extraoral andintraoral hard and soft tissues and may requireinterpretation of information acquired through

PRACTICE MANAGEMENT

NOTESA Supplement to the AAOMS Today Newsletter September/October 2004

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additional diagnostic procedures. Additionaldiagnostic procedures should be reported separately.

The comprehensive evaluation would include theevaluation and recording of the patient’s dental andmedical history and a general health assessment. Itmay typically include the evaluation and recordingof dental caries, missing or unerupted teeth,restorations, occlusal relationships, periodontalconditions (including periodontal charting), hardand soft tissue anomalies, oral cancer screening, etc.

D0160 detailed and extensive oral evaluation — problemfocused, by reportA detailed and extensive problem focusedevaluation entails extensive diagnostic and cognitivemodalities based on the findings of a comprehensiveoral evaluation. Integration of more extensivediagnostic modalities to develop a treatment planfor a specific problem is required. The conditionrequiring this type of evaluation should bedescribed and documented. Examples of conditionsrequiring this type of evaluation may includedentofacial anomalies, complicated perio-prostheticconditions, complex temporomandibulardysfunction, facial pain of unknown origin,conditions requiring multi-disciplinary consultation,etc.

D0350 oral/facial photographic imagesThis includes photographic images, including thoseobtained by intraoral and extraoral cameras,excluding radiographic images. These photographicimages should be a part of the patient’s clinicalrecord

D0415 collection of microorganisms for culture andsensitivity

D4210 gingivectomy or gingivoplasty — four or morecontiguous teeth or bounded teeth spaces perquadrantInvolves the excision of the soft tissue wall of theperiodontal pocket by either an external or aninternal bevel. It is performed to eliminatesuprabony pockets after adequate initialpreparation, to allow access for restorative dentistryin the presence of suprabony pockets, and to restorenormal architecture when gingival enlargements orasymmetrical or unaesthetic topography is evidentwith normal bony configuration.

D4211 gingivectomy or gingivoplasty — one to threecontiguous teeth or bounded teeth spaces perquadrantInvolves the excision of the soft tissue wall of theperiodontal pocket by either an external or aninternal bevel. It is performed to eliminatesuprabony pockets after adequate initialpreparation, to allow access for restorative dentistryin the presence of suprabony pockets, and to restore

normal architecture when gingival enlargements orasymmetrical or unaesthetic topography is evidentwith normal bony configuration.

D4240 gingival flap procedure, including root planing —four or more contiguous teeth or bounded teethspaces per quadrantA soft tissue flap is reflected or resected to allowdebridement of the root surface and the removal ofgranulation tissue. Osseous recontouring is notaccomplished in conjunction with this procedure.May include open flap curettage, reverse bevel flapsurgery, modified Kirkland flap procedure, Widmansurgery, and modified Widman surgery. Thisprocedure is performed in the presence of moderateto deep probing depths, loss of attachment, need tomaintain aesthetics, need for increased access to theroot surface and alveolar bone, and to determinethe presence of a cracked tooth, fractured root, orexternal root resorption. Other separate proceduresincluding, but not limited to, D3450, D3920,D4263, D4265, D4266, D4267 and D7140 may berequired concurrent to D4240.

D4241 gingival flap procedure, including root planing —one to three contiguous teeth or bounded teethspaces per quadrantA soft tissue flap is reflected or resected to allowdebridement of the root surface and the removal ofgranulation tissue. Osseous recontouring is notaccomplished in conjunction with this procedure.May include open flap curettage, reverse bevel flapsurgery, modified Kirkland flap procedure, Widmansurgery, and modified Widman surgery. Thisprocedure is performed in the presence of moderateto deep probing depths, loss of attachment, need tomaintain aesthetics, need for increased access to theroot surface and alveolar bone, and to determinethe presence of a cracked tooth, fractured root, orexternal root resorption. Other separate proceduresincluding, but not limited to, D3450, D3920,D4263, D4265, D4266, D4267 and D7140 may berequired concurrent to D4240.

D4260 osseous surgery (including flap entry and closure)— four or more contiguous teeth or bounded teethspaces per quadrantThis procedure modifies the bony support of theteeth by reshaping the alveolar process to achieve amore physiologic form. This may include theremoval of supporting bone (ostectomy) and/ornon-supporting bone (osteoplasty). Other separateprocedures including, but not limited to, D3450,D3920, D4263, D4264, D4265, D4266, D4267,D6010 and D7140 may be required concurrent toD4260.

D4261 osseous surgery (including flap entry and closure)— one to three contiguous teeth or bounded teethspaces per quadrantThis procedure modifies the bony support of theteeth by reshaping the alveolar process to achieve a

AAOMS PRACTICE MANAGEMENT NOTES

September/October 2004 3

more physiologic form. This may include theremoval of supporting bone (ostectomy) and/ornon-supporting bone(osteoplasty). Other separateprocedures including, but not limited to, D3450,D3920, D4263, D4264, D4265, D4266, D4267,D6010 and D7140 may be required concurrent toD4260.

D4263 bone replacement graft — first site in quadrantThis procedure involves the use of osseousautografts, osseous allografts, or non-osseous graftsto stimulate periodontal regeneration when thedisease process has led to a deformity of the bone.This procedure does not include flap entry andclosure, wound debridement, osseous contouring,or the placement of biologic materials to aid inosseous tissue regeneration of barrier membranes,including, but not limited to, D4240, D4241,D4260, and D4261, D4265, D4266 and D4267.Definition for the term “site” precedes code D4210.

D4265 biologic materials to aid in soft and osseous tissueregenerationBiologic materials may be used alone or with otherregenerative substrates such as bone and barriermembranes, depending upon their formulation andthe presentation of the periodontal defect. Thisprocedure does not include surgical entry andclosure, wound debridement, osseous contouring,or the placement of graft materials and/or barriermembranes, including, but not limited to D4240,D4241, D4260, D4261, D4263, D4264, D4266,and D4267.

D4273 subepithelial connective tissue graft procedures, pertoothThis procedure is performed to create or augmentgingiva, to obtain root coverage to eliminatesensitivity and to prevent root caries, to eliminatefrenum pull, to extend the vestibular fornix, toaugment collapsed ridges, to provide an adequategingival interface with a restoration or to coverbone or ridge regeneration sites when adequategingival tissues are not available for effectiveclosure. There are two surgical sites. The recipientsite utilizes a split thickness incision, retaining theoverlying flap of gingiva and/or mucosa. Theconnective tissue is dissected from the donor siteleaving an epithelialized flap for closure. After thegraft is placed on the recipient site, it is coveredwith the retained overlying flap.

D4276 combined connective tissue and double pediclegraft, per toothAdvanced gingival recession often cannot becorrected with a single procedure. Combined tissuegrafting procedures are needed to achieve thedesired outcome.

D4341 periodontal scaling and root planing — four ormore teeth per quadrantThis procedure involves instrumentation of thecrown and root surfaces of the teeth to removeplaque and calculus from these surfaces. It isindicated for patients with periodontal disease andis therapeutic, not prophylactic, in nature. Rootplaning is the definitive procedure designed for theremoval of cementum and dentin that is rough,and/or permeated by calculus or contaminated withtoxins or microorganisms. Some soft tissue removaloccurs. This procedure may be used as a definitivetreatment in some stages of periodontal diseaseand/or as a part of pre-surgical procedures inothers.

D6000-D6199 Implant ServicesLocal anesthesia is usually considered to be part ofimplant services procedures. Report surgicalimplant procedures using codes in this section.

D6056 prefabricated abutment — includes placementA connection to an implant that is a manufacturedcomponent usually made of machined high noblemetal, titanium, titanium alloy or ceramic.Modification of a prefabricated abutment may benecessary, and is accomplished by altering its shapeusing dental burrs/diamonds.

D6057 custom abutment — includes placementA connection to an implant that is a fabricatedcomponent, usually by a laboratory, specific for anindividual application. A custom abutment istypically fabricated using a casting process andusually is made of noble or high noble metal. A‘UCLA abutment’ is an example of this typeabutment.

D7000-D7999 Oral and Maxillofacial SurgeryLocal anesthesia is usually considered to be part oforal and maxillofacial surgery procedures. Fordental benefit reporting purposes a quadrant isdefined as four or more contiguous teeth and/orteeth spaces distal to the midline.

D7111 extraction, coronal remnants — deciduous toothRemoval of soft tissue-retained coronal remnants.

D7140 extraction, erupted tooth or exposed root (elevationand/or forceps removal)Includes routine removal of tooth structure, minorsmoothing of socket bone, and closure, asnecessary.

D7210 surgical removal of erupted tooth requiringelevation of mucoperiosteal flap and removal ofbone and/or section of toothIncludes cutting of gingiva and bone, removal oftooth structure, minor smoothing of socket boneand closure.

4 September/October 2004

This is number 84 in a series of articles on practice management and marketing for oral and maxillofacial surgeons developedunder the auspices of the Committee on Practice Management (Larry J. Moore, chair, Robert W. Emery, Brent T. Garrison, JerryL. Halpern, Rickey L. Hurst, Donald P. Lewis, Jr., Robert T. Watts, Jr., and Robert L. Coles, consultant) and AAOMS staff.Complete sets of previously published Practice Management Notes are available online at aaoms.org.

All articles in Practice Management Notes are published only with the consent of the authors, who have expressly warrantedthat their works are original and do not violate copyright or trademark laws. AAOMS is not responsible for any violations ofcopyright/trademark law on the part of these authors.

D7280 surgical access of an unerupted toothAn incision is made and the tissue is reflected andbone removed as necessary to expose the crown ofan impacted tooth not intended to be extracted.

D7285 biopsy of oral tissue — hard (bone, tooth)For removal of specimen only. This code involvesbiopsy of osseous lesions and is not used forapicoectomy/periradicular surgery

D7286 biopsy of oral tissue – softFor surgical removal of an architecturally intactspecimen only. This code is not used at the sametime as codes for apicoectomy/periradicularcurettage.

D7287 exfoliative cytological sample collectionFor collection of non-transepithelial cytologysample via mild scraping of the oral mucosa.

D7490 radical resection of maxilla or mandiblePartial resection of maxilla or mandible; removal oflesion and defect with margin of normal appearingbone. Reconstruction and bone grafts should bereported separately.

D7950 osseous, osteoperiosteal, or cartilage graft of themandible or facial bones — autogenous ornonautogenous, by reportThis code may be used for sinus lift procedureand/or for ridge augmentation. It includes obtainingautograft and/or allograft material. Placement of abarrier membrane, if used, should be reportedseparately.

D7955 repair of maxillofacial soft and/or hard tissue defectReconstruction of surgical, traumatic, or congenitaldefects of the facial bones, including the mandible,

may utilize autograft, allograft, or alloplasticmaterials in conjunction with soft tissue proceduresto repair and restore the facial bones to form andfunction. This does not include obtaining the graftand these procedures may require multiple surgicalapproaches.

D9310 consultation (diagnostic service provided by dentistor physician other than practitioner providingtreatment)Type of service provided by a dentist whose opinionor advice regarding evaluation and/or managementof a specific problem may be requested by anotherdentist, physician or appropriate source. The dentistmay initiate diagnostic and/or therapeutic services.

DELETIONS

D6020 abutment placement or substitution: endostealimplantAn abutment is placed to permit fabrication of adental prosthesis. The procedure may include theremoval of a temporary healing cap or replacementwith an abutment of alternate design. The intentionof this code is to report this procedure by otherthan the dentist who placed the implant.

D7281 surgical exposure of impacted or unerupted toothto aid eruptionDense fibrous tissue overlying an impacted orunerupted tooth is reflected and any overlying boneis removed. This procedure may also be performedin conjunction with a separate soft tissue graftprocedure.

Be sure to participate in AAOMS Coding Courses to stay abreast of the dynamic, ever-changing world of coding andreimbursement. AAOMS offers three levels of coding courses, some in person and others in an online format. Choose thelevel and format that is best for you. If you are an independent learner equipped with basic internet skills, the online formatmay be best for you. If you like the ability to network in person with peers, an in person course may be the way to go. Visitaaoms.org to view a brochure.