The Curious Relationship Between CPT Codes and Actual Treatments

by  Find-A-Code™
Jan 30th, 2023

Common sense seems to dictate that medical billing codes, like CPT codes for example, are only considered after medical treatment has been provided. After all, the codes are simply a representation of diagnosed conditions and treatment services provided – for billing purposes. But there is a curious relationship between these codes and actual treatments.

If you need proof, look no further than an article recently published on the Dentistry IQ website. The article discusses a brand-new CPT code doctors can utilize when offering a certain dental procedure. The way the article is written suggests that the new CPT code actually encourages doctors to perform this procedure. Conversely, the implication is that the procedure would not be performed without a code to back it up.

CPT Codes Equal Payment

The procedure in question involves applying silver diamine fluoride (SDF) to a cavity. Your GP, not being trained as a dentist, couldn't treat that cavity by drilling into the tooth and filling it. But they can brush on a thin layer of SDF. What does that accomplish? It stops the cavity from getting any bigger and prevents bacteria growth.

A doctor wishing to offer the procedure undoubtedly wants to be paid for it. That's where CPT codes come in. A CPT code equals payment. If there is no code for a given procedure, a doctor cannot bill the insurance company for it. Then they do not get paid.

This is the whole idea behind the Dentistry IQ post. Even though doctors could apply the SDF treatment in the past, how many actually would do so without a means to bill insurance companies? The American Medical Association's (AMA) approval of a new CPT code changes things.

The Potential Effect on Dentistry

Digging into this new CPT code suggests that doctors might now be encouraged to perform the procedure because they can bill for it. By extension, it reveals the unpleasant truth that actual treatments might be tied to a doctor's ability to bill for them. But there is something else in play with this particular code: how it affects dentistry.

Applying SDF to a cavity temporarily solves the problem. It is considered an effective treatment for people who don't see their dentists often enough. But for the SDF treatment to continue being effective, it needs to be repeated from time to time. Would patients rather see a GP for regular SDF treatments than visit the dentist to have the problem permanently taking care of?

It is probably a safe bet that dentists would argue in favor of the more traditional approach. Drilling out a cavity so that it can be properly filled virtually eliminates the danger of any further problems with that tooth. Applying a layer of SDF stops cavity progression and fight bacteria, but for how long?

CPT Codes Are Constantly Evolving

There are undoubtedly some doctors who appreciate having a new CPT code for the SDF procedure. Likewise, there are probably an equal number of dentists unhappy about it. And yet, CPT codes are always evolving. Just for 2023 alone, the AMA has approved dozens of codes clinicians, medical coders, and billers will be utilizing for the foreseeable future.

One can look at CPT codes as little more than a tool for streamlining the billing process. That was their original intention. But if doctors are not offering available treatments and procedures for lack of billing codes, then CPT codes become a primary driver of patient care.

CPT codes and actual treatments are subject to a curious relationship. It is a relationship that probably should be broken for the benefit of patients.