In Dilaine's Coding Corner

CDT code D1355 is a new code for CDT 2021, which became effective, January 1, 2021. Let’s take a look at what procedure this new code represents. 

D1355 caries preventive medicament application – per tooth

For primary prevention or remineralization. Medicaments applied do not include topical fluorides.

How should I use Code D1355?

The intended use of D1355 is for application of a medicament to a single tooth for prevention or remineralization purposes. The descriptor specifically states that this does not include topical fluorides. Medicaments such as, but not limited to, silver diamine fluoride, silver nitrate, and chlorhexidine, etc. are commonly used to prevent decay in specific areas in high risk patients. 

Indications of use are but not limited to application of medicament in areas of root exposure, around orthodontic bands, etc.  D1355 is reported per tooth. 

How do I get Code D1355 paid by dental insurance?

Coverage will vary by plan. Include a caries risk assessment in the patient chart to show the risk (i.e., low, moderate, or high) of caries determined. Attach a narrative to the claim indicating the caries risk. For example, “Patient is at high risk for caries. Silver nitrate applied to the root surface for caries prevention.” It is not necessary to attach the caries risk assessment to the claim however, some payers may ask for the caries risk assessment. The record must include the documentation of the assessment to prove medical necessity of the “high caries risk”. 

Some dental payers (i.e., Medicaid, ACA plans, etc.) may require an ICD-10-CM diagnosis code for D1355. Below is a list of commonly applied diagnoses codes to document and report the reason the treatment is required. When applying diagnostic codes, only what is documented can be reported. 

Z91.841 risk for dental caries, low

Z91.842 risk for dental caries, moderate

Z91.843 risk for dental caries, high

Z91.849 unspecified risk for dental caries

*The list of ICD-10-CM codes is not an exhaustive list. Always apply the diagnosis code specific to each patient’s condition. 

Why was D1355 added to the CDT?

The addition of D1355 closes a gap in the CDT code set. CDT includes D1206 topical application of fluoride – varnish, D1208 topical application of fluoride, excluding varnish, and D1354 interim caries arresting medicament application – per tooth. However, neither of the existing codes apply to this procedure. Codes D1206 and D1208 report full mouth applications of topical fluoride for preventive measures. While the same or similar medicaments are commonly used for arresting caries, D1354 is not intended for prevention of caries but rather arrests an active carious lesion. 

Always document and report what you do using the current CDT code set. Documentation is key in proving medical/dental necessity and for reimbursement purposes. Note, some payers are no longer accepting narratives; requiring chart notes instead. 

For more 2021 coding information, visit Dilaine’s Coding Corner.

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