Below is an email that I received regarding Aetna policy changes. Read carefully, they will effect your practice. Make sure your front desk is aware.
One of the big changes is D2950 Core buildup – they are request pre and post op x-rays or photographs. Another is D4355 – Gross Debridement can not be done the same day as an exam D0150, D0120
Network Bulletin
Date: May 2, 2017
From: Lisa Stepanian, Executive Director, Dental Network Operations
Subject: Claim administration policy changes
Applies to: All Aetna Dental® Plans
From time to time, we update our dental claims administration policies. This Bulletin is to let you know of the following changes that will take effect for all Aetna Dental® plans on July 17, 2017:
D4355 – Debridement, full mouth to enable comprehensive periodontal evaluation and diagnosis
To align with the ADA descriptor of D4355, the following changes are being made to our claim processing policies:
D4355 will be denied when performed on the same date of service as D0120.
D0145, D0150, D0160 and D0180 will be denied when performed on the same date of service as D4355.
D1110, D1120, D4910, D4341, D4342 and D4346 will be denied when performed on the same date of service as D4355.
D0210 – Intraoral – complete series of radiographic images
To align with the ADA descriptor of D0210, additional intraoral periapical D0220 & D0230 and bitewing radiographic images D0270, D0272, D0273, D0274 and D0277 will not be separately eligible when performed on the same date of service as D0210.
D0277 – Vertical bitewings – 7 to 8 radiographic images
Bitewing radiographic images D0270, D0272, D0273 and D0274 will be denied when performed on the same date of service as D0277.
D3310, D3320, D3330, D3331, D3332 and D3333 – Endodontic therapy with intraoral periapical radiographic images
To align with the ADA nomenclature for endodontic therapy, periapical radiographic images D0230 will be denied when performed in conjunction with endodontic therapy on the same date of service. D0230 is part of the endodontic therapy. Diagnostic evaluation and images are not part of the endodontic therapy.
D3310, D3320 and D3330 – Endodontic therapy
Claims submitted for D3310, D3320 or D3330 will be denied if there is a history of Root Canal Therapy on the same tooth. Endodontic retreatment should be submitted under codes D3346, D3347 and D3348 for consideration.
D4910 – Periodontal maintenance and D4341/D4342 – Periodontal scaling and root planing
The descriptor for D4910 periodontal maintenance includes removal of bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing as well as polishing where indicated. D4341/D4342 periodontal scaling and root planing is not separately eligible when performed on the same day as a D4910.
Reminder – D2950 – Core build up, including any pins when required
To assure that benefits are being applied appropriately, and to gather data on submitted buildups to inform future plan designs, we now require pre-and post-operative radiographic images or photographs that illustrates the need for and placement of a buildup.
