Note- the following is the interpretation of codes and billing by Dr. Amanda Wilson and StraightSmile Solutions. Please consult your own dental practice act in your own state or country and the insurance company you are partnering with. For a 1:1 coaching session by Dr. Wilson to optimize orthodontics in your practice, please visit www.straightsmilesolutions.com and click on “contact us” to schedule a complimentary coaching session.
Not all orthodontic treatment is equal. In its simplest form, limited treatment would focus a single tooth or a few teeth or on all the teeth in just one arch. It may be directed at the only existing problem, or at only one aspect of a larger problem in which a decision is made to decline comprehensive therapy. In other words, let’s say a patient comes in with a 9mm overjet and 100% overbite but she doesn’t want bite correction. She just wants a diastema between her top teeth corrected and no lower braces. That would be limited. Most DTC (direct-to-consumer) care like Candid® and SmileDirectClub® is limited, but not all. Six Month Smiles® is also limited because they only use round wires and they don’t correct bites or torque teeth. Most Invisalign® Express and Lite would be considered limited.
Comprehensive treatment would involve idealizing the bite, smile, alignment of all teeth, and soft tissue esthetics. It may or may not involve taking and interpreting a cephalometric x-ray. Most Invisalign Moderate and Comprehensive treatment would be comprehensive because you can correct transverse issues, vertical issues and AP (anterior-posterior) issues. Straightwire braces would also be comprehensive as long as you are taking the patient up to rectangular wires and expressing torque and improving the bite.
Interceptive: (D8050- D8060)
Phase I is performed during the early mixed dentition (when a lot of baby teeth are present) to address a functional or skeletal issue. This procedure lasts for about 6 – 18 months. After this Phase 1, a child may or may not need further orthodontic treatment (Phase 2). If a child does need further treatment with Phase 2, a new contract will have to be signed and new payments will have to be made. Phase I Treatment can often simplify or eliminate the need for full comprehensive orthodontic treatment because it is designed to encourage jaw growth and correct problems on its early development, reduce crowding and likelihood of impactions. Phase 1 may just be removable or fixed appliances to fix a bite and may or may not include some braces or aligners on the front teeth. It is designed to fix functional issues. Cosmetic issues may be addressed in Phase 2.
That being said, there are some codes that fall under the orthodontic section that are procedure-specific. There are codes for fixed and removable habit appliances (D8210, D8220) such as those used to break a thumb-sucking habit. It is important to know that codes for these appliances include their removal. There are also codes for exams (if you charge a fee for those), diagnostic records, and even new codes for CBCT images. These codes for procedures such as gingivectomies, or surgical exposure of an impacted tooth. These should only be submitted once the procedure is performed, not at the beginning of orthodontic treatment.