When is D8670 used?
The D8670 dental code represents a "Periodic orthodontic treatment visit." This CDT code applies to regular, scheduled appointments throughout active orthodontic care, including adjustments, wire replacements, or progress evaluations. It excludes initial appliance placement or final removal procedures; rather, it encompasses the continuing visits that monitor treatment advancement. Dental practices should apply D8670 for each regular visit involving active orthodontic management, usually scheduled every 4–8 weeks based on the individual treatment protocol.
D8670 Charting and Clinical Use
Proper documentation is vital for correct billing and insurance coverage. For every D8670 visit, record the exact procedures completed—including archwire modifications, bracket inspections, or elastic replacements—and document any patient-specific findings or guidance. Typical clinical situations for D8670 include:
Regular adjustment of orthodontic devices
Evaluating tooth movement and treatment progress
Changing or adjusting wires and elastic bands
Managing minor appliance maintenance during ongoing treatment
Make sure each visit record clearly justifies the D8670 usage, including date, practitioner, and specifics of the orthodontic care provided. This record-keeping is essential for insurance reviews and claim disputes.
Billing and Insurance Considerations
To optimize payment and reduce claim rejections when submitting D8670, implement these strategies:
Confirm orthodontic coverage prior to starting treatment, including visit frequency limits and benefit maximums.
Provide a detailed orthodontic treatment outline with the first claim, specifying anticipated periodic visit numbers.
Submit D8670 for each appropriate visit during treatment, making sure each claim includes supporting clinical documentation.
Examine benefit statements quickly to monitor payments and spot any issues.
When claims are rejected, file appeals with thorough documentation demonstrating the medical necessity of the periodic visit.
Certain insurers may include periodic visits in a comprehensive orthodontic payment, while others need separate billing for each D8670 visit. Always review insurer requirements and adjust your billing practices as needed.
How dental practices use D8670
Take a 14-year-old patient receiving active orthodontic treatment. During a routine six-week appointment, the orthodontist changes the archwire, examines bracket condition, and supplies new elastic bands. The treatment record details the modifications, patient cooperation, and hygiene guidance provided. The practice bills D8670 for this appointment, including the comprehensive progress documentation with the claim. The insurance policy permits periodic visits every 30 days, resulting in smooth claim processing and payment. Should the policy include frequency restrictions, the practice would reference the treatment outline and file an appeal when needed, supported by the complete visit documentation.
Through proper understanding of D8670 application and comprehensive record-keeping, dental offices can maintain accurate billing practices, efficient insurance processing, and effective revenue management.
Common Questions
Is it possible to bill D8670 alongside other orthodontic procedure codes on the same date?
D8670 can be billed with other orthodontic procedure codes on the same day only when distinct and separately identifiable services are performed. It's crucial to verify the specific payer's policies, as certain insurance plans may bundle orthodontic services together or impose restrictions on billing multiple codes for the same service date. Proper documentation that clearly supports the necessity and distinctness of each billed procedure is always required.
What is the typical billing frequency for D8670 during orthodontic treatment?
The billing frequency for D8670 varies based on the individual patient's treatment plan and insurance policy restrictions. Typically, D8670 is billed monthly or every two months to correspond with regular adjustment appointments. Many insurance plans impose specific frequency limits, such as allowing only one D8670 claim per month, making it essential to verify coverage benefits and comply with payer requirements to prevent claim denials.
What steps should be taken when a D8670 claim gets denied by the insurance company?
When a D8670 claim is denied, the dental office should immediately examine the Explanation of Benefits (EOB) to identify the denial reason. Typical causes include insufficient documentation, frequency limit violations, or missing pre-authorization. To resolve the denial, submit any required documentation, correct identified errors, or file a timely appeal including supporting clinical notes and treatment records. Maintaining regular communication with the payer is essential for resolving denials and obtaining proper reimbursement.