NEW APEXOGENESIS CODE RAISES QUESTIONS - 02/16/2009
Since its introduction in CDT 2009, a surprising number of people have called our support department to ask the difference between D3222 (apexogenesis) and D3220 (therapeutic pulpotomy). To answer this question, it may be helpful to first review the therapeutic pulpotomy procedure.
Therapeutic Pulpotomy
The descriptor for a therapeutic pulpotomy indicates that it may be performed on primary teeth or permanent teeth. However, the reality is that most pulpotomies are performed on primary teeth that have caries into the pulp.
A therapeutic pulpotomy involves removing the pulp in the pulp chamber and placing a dressing on the remaining part of the pulp in the canals. On a primary tooth, the goal of a therapeutic pulpotomy is to maintain the vitality of the remaining pulp so the baby tooth will remain in place until it falls out naturally. After a therapeutic pulpotomy is performed, a restoration of some sort (or prefabricated crown) must be placed on the primary tooth.
In some situations, a therapeutic pulpotomy may need to be performed on a permanent tooth. This typically occurs when a patient is unable to proceed with root canal therapy, typically due to emotional, financial, or medical reasons.
Open and Broach
Some dental practices routinely report a pulpotomy code (D3220) for an open and broach procedure prior to completing root canal therapy, despite the fact that the descriptor for a therapeutic pulpotomy specifically states that D3220 is not to be construed as the first stage of root canal therapy. Remember that most therapeutic pulpotomies are performed on primary teeth and are definitive procedures, whereas an open and broach is a preliminary procedure performed on a permanent tooth, usually to relieve pain, prior to a root canal.
An open and broach procedure involves removing part of the infected pulp so the rest of the pulp tissue has room to swell and pain is reduced. The dentist opens the tooth by drilling into the pulp space and uses an instrument called a "broach" to remove as much pulp tissue as will come out easily. A temporary filling is placed, and the patient returns on another day for completion of the root canal or is referred to an endodontist.
An open and broach is considered the first stage of a root canal and is not billable as a separate procedure unless the patient interrupts the schedule in acute pain, and the root canal is completed on a separate day. When this is the case, the open and broach can be reported separately as pulpal debridement (D3221).
An open and broach can be billed on the same day as a root canal only if one dentist opens the tooth to relieve a patient of acute pain prior to referring the patient to another dentist (e.g., an endodontist) to start root canal therapy. In this case, the dentist opening the tooth could bill pulpal debridement (D3221). Keep in mind that some dental plans will only consider payment if a narrative is sent explaining that the patient was in acute pain and was referred to the endodontist afer the tooth was opened. Another option is to bill D9110, palliative treatment. However, when covered, D3221 often yields a higher allowable fee than D9110.
Apexogenesis
Now back to the original question: How does apexogenesis differ from a therapeutic pulpotomy? Apexogenesis is performed on an immature permanent tooth which has pulp exposure due to caries or trauma. Genesis means the creation of, development of, or coming into being of something, and the apex of the tooth is the end of the root. So, apexogenesis means the creation or development of an apex. The goal is to encourage normal maturation of an immature tooth root. The dentist removes only the infected part of the pulp from the pulp chamber (which is why it is considered a "partial pulpotomy") and places medication directly onto the pulp. A filling is then placed. If the pulp heals and the apex develops, no additional endodontic treatment is necessary. However, if not successful, then apexification will be necessary.
Quick Review
A therapeutic pulpotomy is most commonly performed on a primary tooth with caries into the pulp. It typically involves the removal of all the pulp from the pulp chamber with the goal of retaining tooth vitality until the primary tooth falls out naturally.
While not as common, a therapeutic pulpotomy may also be performed on a permanent tooth to buy time until the patient is able to proceed with a root canal. There may be medical, emotional, or financial reasons why the root canal must be delayed. Also, remember that a therapeutic pulpotomy (D3220) is not to be billed as the first stage of root canal therapy. In most cases, it is performed on primary teeth and is a definitive procedure.
An open and broach is considered an inherent part of a root canal and should not be billed separately unless one of the following conditions apply:
The patient is in acute pain, interrupts your schedule, and the root canal is completed on a separate day,
The patient is in acute pain, you perform an open and broach and then refer the patient to another dentist (e.g., endodontist) for the root canal, or
You perform an open and broach because the patient is in acute pain, and the patient never returns to complete the root canal.
Apexogenesis is performed on an immature permanent tooth with pulp exposure due to caries or trauma and involves only removing the infected part of the pulp in the pulp chamber (which is why it is considered a partial pulpotomy), leaving as much healthy pulp as possible, which is necessary to create the dentin needed for continued root development.
The goal of apexogenesis is to develop a root end (apex) and avoid apexification. If apexogenesis is not successful, then apexification will be necessary.
Hopefully, this information will help you explain the pulpotomy, open and broach, and apexogenesis procedures to your patients and report the appropriate codes, which is, of course, essential to obtaining proper reimbursement.
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NEW MEDICAL CLAIM FORM IN THE WORKS - 04/01/2013
The National Uniform Claims Committee
(NUCC) has revised the CMS-1500 claim form
(version 08/05). ...more
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I am amazed at the amount of documentation needed to get payment from some carriers. We carriers need to make this process much easier for providers. Vicki—I would not want to miss a minute of your class!
Jackie Neufeld
Eugene, OR Class
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CDT
Interactive
Coding Workshop
For dental teams who find it difficult to leave the office for a full day of training, this DVD set (6 hours) is a flexible and cost-effective way to learn how to properly code, document, and improve reimbursement for dental services.
Price: $295
(includes shipping)
To order: Call 888-825-0298
or for more information
click here
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