D3310 - ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION)

1. It is inappropriate to report pulpal debridement (D3221) or palliative (D9110) at the initial, regularly scheduled root canal visit to receive a higher overall reimbursement. These codes require the relief of acute pain. If a root canal is initiated (the length determined and the regularly scheduled instrumentation of the canal begun), the root canal codes (D3310, D3320, or D3330) should be used to report the service. Although the terminology used on the current ADA claim form permits reporting of the root canal on the start date, most third party payors often require the root canal be submitted using the completion date. However, the ADA Policy Eligibility and Payment Dates for Endodontic Treatment (1994:674) encourages the completion date as the date of service.

2. For treatment to alleviate acute pain at an emergency visit by debriding and removing all the pulpal tissue, consider the pulpal debridement (D3221) code to describe this emergency procedure. Also see palliative (D9110) in situations where only part of the pulpal tissue is removed. The root canal would be completed on a subsequent date.

3. If an endodontic access opening is done through a crown which is already permanently cemented/bonded, it is inappropriate to report restoration of the endodontic access opening as a core buildup (D2950). The purpose of a core buildup, reported as D2950, is for retention of a crown. Report a one surface amalgam or composite (see comments below, Limitation #6) to describe the access opening hole closure restorative procedure.

4. A root canal procedure performed to allow the placement of an overdenture attachment in the tooth is an "elective" procedure. An "elective" root canal procedure completed to aid in the delivery of another more "specialized* procedure, like an overdenture, should be submitted, but is generally not reimbursed.

5. For a routine, regularly scheduled visit, do not report pulpal debridement (D3221) at the first visit of a scheduled two appointment root canal. This code requires the relief of acute pain.


WATCH

It is inappropriate to report endodontic therapy, anterior (D3310) for a one canal premolar. It should be reported as D3320. The determination of the endodontic code that describes the endodontic procedure provided is based on the tooth type rather than the number of canals treated. Report D3320 to describe a root canal provided for a premolar, regardless of the number of canals treated.


COMMENTS

1. Report a root amputation (D3450) separately.

2. An oral evaluation and preliminary diagnostic radiograph(s) for initial diagnosis should be reported separately from the root canal procedure. An oral evaluation would not be reported if the need for root canal treatment had been previously diagnosed. Only the initial diagnostic radiograph(s) should be reported, not working radiographs. Working radiographs are considered part of the endodontic procedure. If multiple visits are necessary, the diagnostic radiographic images should be reported prior to, or on the first visit date.

3. Enter the tooth number being treated in Box 27 of the 2024 ADA Dental Claim Form.


LIMITATIONS

1. "Working" or intraoperative radiographs and post-treatment images (within thirty days of treatment) are considered a part of the root canal global fee. Note: diagnostic images done prior to initiation of endodontic treatment are considered a separate diagnostic procedure and may be reimbursed. An evaluation may be submitted at the diagnosis appointment; however, plan limitations may limit reimbursement.

2. Reimbursement for an under filled or over filled root canal may be disallowed by payor.

3. D3310 could be used to report a root canal on an anterior primary tooth in a patient who is missing the permanent successor tooth when the primary tooth is sealed using a non-resorbable (gutta-percha type) material.

4. A pulpal debridement (D3221) procedure may be reported when performed to relieve acute pain if endodontic treatment is not initiated on the same service date by the same office. "Starting" an endodontic procedure involves establishing working length and beginning the use of a sequence of files to instrument and enlarge the canal. Some payors may "re-map" D3221 to a pulpotomy (D3220) or palliative (D9110) for reimbursement. Also see D9110.

5. A root canal submitted for reimbursement and paid based on the start date that is never completed may be considered overbilling and is subject to a fee adjustment by the third party payor. A refund may be requested by the payor for all or part of the fee. Any cancellations and attempts to reschedule the patient for completion of treatment must be noted in the clinical record. Notify the payor that the root canal was not completed. Submit a request for the alternate benefit D3999, unspecified procedure, by report, to recoup for the time and materials used. Payors typically require the root canal completion date be used when reporting endodontic therapy; however, state law and/or contract language could indicate or require otherwise.

6. The closure of an endodontic access hole is reported as a separate procedure. Use codes such as a one surface amalgam or composite to report the restoration for access hole closure if the crown is intact and in place. Restorations to seal the access opening are generally reimbursed at 80% of the payor's fee. Some third party contracts include access closure in the global fee for the endodontic procedure. It is recommended that a brief narrative be included with the claim that describes the restoration technique used and reason for the procedure. "An occlusal composite was placed for access hole closure." The payor may have tracked the tooth with a crown and may reject the composite restoration without a narrative.

7. If the crown is removed, or comes off, then a core buildup (D2950) or prefabricated post and core (D2954) may be performed and reported. The exisitng or new crown would be placed subsequently after the core buildup or post and core.

8. The D2980 crown repair code now reports "necessitated by restorative failure" in its nomenclature so now either a one surface amalgam or composite is the code to use to report access hole closure, not crown repair. However, some payor's still reimburse endondontic access closure with D2980.


NARRATIVES

1. If documentation is requested: "See attached pre- and post-op radiographic images."
2. If diagnostic radiographic images are denied, submit a narrative stating they were taken prior to initiation of endodontic therapy and are nm "working' or intraoperative radiographs.