Use of the Fluoride Varnish Billing Code in a Tertiary Care Center Setting

Abstract

Introduction: Dental caries is the most common chronic disease in children from birth through 5 years of age. Application of fluoride varnish (FV) is recommended for children younger than 6 years every 3 to 6 months by the United States Preventive Services Task Force. The purposes of this study were to (1) assess use and reimbursement of Current Dental Terminology (CDT) D1206 and Current Procedural Terminology (CPT) 99188 codes, which are the billing codes for FV application; (2) determine when and by whom each FV code was used; and (3) summarize the associated clinical notes. Methods: Using the electronic medical record data warehouse from a single tertiary teaching hospital and its affiliated primary care clinics, the dates of service, departments, provider names, and patient identifiers associated with codes CDT D1206 and CPT 99188 were collected. The content of clinical notes was reviewed and summarized. The study period was from May 1, 2009 through May 17, 2019. Results: During the 10-year time period, CDT D1206 was used 5 times and CPT 99188 was used 35 times. FV was applied exclusively during well-child visits. Only pediatricians, and no family physicians, applied FV in this setting. Discussion: A single pediatrician championing for FV application increased both the completion of procedure and the appropriate billing in 2019. Conclusion: FV application has been likely underutilized in this Midwestern tertiary teaching hospital and its affiliated clinics. For both family medicine and pediatric offices, an advocate for caries prevention is likely needed for successful implementation of FV application at well-child visits.

Five-year follow-up of an interdisciplinary oral health education program: Clinical practice behaviors in working pediatric nurse practitioners

“…However, few PNPs were providing this service in the inpatient or outpatient medical settings. This finding is similar to published studies that assessed the provider type (physicians, family nurse practitioners, physician assistants, and PNPs) and patients with both public and private medical insurance (Kim et al, 2020; Kranz et al, 2022; Lian et al, 2020). Continued efforts are needed to increase pediatric primary care providers' delivery of fluoride varnish as well as emphasizing generalizability of oral health preventive practices and interventions to specialty clinics and intensive care/acute care settings.…”

Impact on Dental Utilization of the Integration of Oral Health in Pediatric Primary Care Through Quality Improvement

“…Understanding provider-specific factors that may motivate a provider to participate in oral health–related QI projects will be critical to thinking through how best to expand uptake of these activities. Intraoffice champions are associated with project success within the PFK QI program, consistent with other studies where an oral health champion improved FV application rates 15,16,18,36–40. It is likely that the QI medical practices are more engaged with their patients and communities.…”

“…Intraoffice champions are associated with project success within the PFK QI program, consistent with other studies where an oral health champion improved FV application rates. 15,16,18,[36][37][38][39][40] It is likely that the QI medical practices are more engaged with their patients and communities. Furthermore, QI medical practices, alongside FV application, have incorporated oral health education by clinical staff during well-child visits, which may result in greater awareness among families of the importance of oral health, thereby increasing uptake of preventive dental visits.…”

Prevención de la caries de infancia temprana.

“…La CIT es considerada como enfermedad multifactorial debido a que se encuentra influenciada por factores biomédicos como la dieta, la microbiota oral, y a los determinantes sociales subyacentes de la salud en los que se incluyen bajo nivel socioeconómico y nivel educativo de los padres, nutrición materna y problemas psicosociales (22)(23)(24)(25). Por lo tanto, al momento de planificar e implementar programas para mejorar la salud bucal es necesario tener en cuenta el huésped susceptible, las bacterias cariogénicas, el sustrato de carbohidratos fermentables y factores vinculados al entorno social (26,27) conocidos como factores de riesgos que se detallan a continuación.…”