Efforts by ADHA Make Impact on ADA Code Reversal Decision

Chicago-March 20, 2003 - The American Dental Hygienists' Association is pleased to announce that in response to efforts by ADHA, the American Dental Association's Committee on Code Revision has reversed problematic language in ADA's Current Dental Terminology, fourth edition (CDT-4) manual, which became effective January 1, 2003.

On that date, a number of changes were made to the previous insurance reporting codes for dental procedures (CDT-3), which ADHA believes created a potentially damaging situation for oral health care consumers.

CDT codes are the recognized dental insurance codes for the entire U.S. and are used by private insurers, Medicaid and other third-party payers. The codes are updated every two years, with the revisions effective at the start of the following calendar year.

The previous definition defined the adult prophylaxis (teeth cleaning) as scaling AND polishing to remove coronal plaque, calculus and stains, while the new definition that took effect in January referred to scaling AND/OR polishing.

According to ADHA President Kimberly K. Benkert, "This seemingly minor change represented a major potential threat to the safety and welfare of the public. The potential harm to the patient is quite clear. Scaling to remove calculus is the preventive element of the prophylaxis, while polishing is a selective cosmetic and esthetic addition to the scaling procedure and has no therapeutic value in preventing or treating periodontal (gum) disease."

Benkert adds that ADHA's concern with this perceived minor change is that it would allow practitioners in states to submit polishing services as a complete and therapeutic prophylaxis.

"It was our position that this would be both misleading and risky for consumers, who might be unaware that a polishing is not a complete prophylaxis," said Benkert.

In response to CDT-4 changes, ADHA initiated several proactive measures to effect a reversal decision. Today's announcement demonstrates the positive results of these actions.

Letters were sent to every state dental board, state consumer protection agencies, dental hygienist members of state dental boards, and state dental hygiene association presidents. In addition, ADHA published an article on CDT-4 in its January 2003 issue of Access, a national magazine that focuses on health and practice news, professional issues, and legislative developments that are important to dental hygienists. Finally, ADHA staff were represented at the ADA's Code Revision Committee (ADA CRC) meeting in February. At the meeting, ADA CRC reversed the language to correctly reflect the minimum level of quality care and protection of the public in CDT-3.

"We still have concerns with the way the prophylaxis code in CDT-4 is worded. In particular, we are concerned with the use of the word 'coronal', which does not address scaling below the gumline," said Tammi O. Byrd, ADHA president-elect. "ADHA will be taking steps to request further clarification of this language."

The primary purpose of ADHA's efforts was to bring attention to this issue with ADA, state boards and state consumer protection offices on an issue that could have detrimental effects on the most important element, the oral health of the consumer, as well as third-party insurers and dental hygienists.

"ADHA is delighted with ADA's decision to reverse CDT-4, due to the successful efforts of its staff and leadership," said Benkert. "The initial code revision to 'and/or' was more than just an insurance issue, it created an ethical dilemma and a potentially harmful effect on the quality of patient care."

ADHA is the largest national organization representing the professional interests of the more than 120,000 dental hygienists across the country.

Dental hygienists are preventive oral health professionals, licensed in dental hygiene, who provide educational, clinical and therapeutic services that support total health through the promotion of optimal oral health.

For more information about ADHA, dental hygiene or the link between oral health and general health, visit ADHA at http://www.adha.org.

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