Diagnostic testing in the dental practice is a continually evolving process. Keeping up with the changes helps us all prepare to help our patients toward optimum health.
My article on documenting CDT codes for viral microorganism cultures published by DrBicuspid.com in September 2024 provided information on testing for microorganisms and subsequent coding and billing. However, the ADA recently made the following announcement: "As of October 2024, no FDA-approved salivary diagnostic tests are available for assessing the risk of periodontal disease, dental caries, or head and neck cancer."
The newly published "ADA Guide to Salivary Testing" discusses explicitly the diagnosis and procedures related to the following specific codes:
- D0417 -- Collection and preparation of saliva samples for laboratory diagnostic testing
- D0418-- Analysis of saliva sample (It is a chemical or biological analysis of saliva sample for diagnostic purposes)
- D0419 -- Assessment of salivary flow by measurement. This procedure is for identifying low salivary flow in patients at risk for hyposalivation and xerostomia, as well as the effectiveness of pharmacological agents used to stimulate saliva production
The above codes correspond to specific diagnostic procedures and ensure proper documentation and reporting for laboratory and non-laboratory saliva tests. Understanding the distinction between diagnostic tests and wellness-focused saliva tests is important for proper coding.
Note: Dental practices must use a certified laboratory (laboratory-based) to process saliva samples to detect biomarkers associated with periodontal disease. For samples that are sent out to the laboratory, the CDT code is D0417.
The resulting analysis by the laboratory would be coded D0418. The process must be detailed, and the results must be documented carefully in the patient's chart.
Non-laboratory or in-office or at-home saliva testing is considered wellness monitoring. The testing for biomarkers allows the patient to collect a saliva sample on a test card and then use a mobile app to receive instant results. Testing in this fashion is not intended to diagnose or treat disease. Since this test is not used to establish a clinical diagnosis, the procedure would be coded as a D9999 -- Unspecified adjunctive procedure by report -- and submitted with detailed documentation (chart notes).
Saliva testing is a valuable adjunct to periodontal disease detection and monitoring. It is noninvasive, provides early detection, and monitors treatment effectiveness. However, testing is not a substitute for a comprehensive periodontal examination, which is CDT code D0180.
Editor's note: References are available upon request.
Estela Vargas, CRDH, is the founder and CEO of Remote Sourcing, a dental insurance billing and revenue recovery service. She is a graduate of Miami Dade College's dental hygiene program. Vargas' extensive background in the clinical arena of dentistry is coupled with her experience as a practice administrator and business executive.
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
