INSURANCE BENEFITS
Defining the Difference between an Indirect Pulp Cap and
a Base or Liner
For the most part, dental teams recognize the distinction If a permanent restoration is placed at the same visit as the pulp
between a direct pulp cap and a base or liner. Recently, the AAPD treatment, most insurance companies consider this to be a base or
has received several calls regarding the difference between an indi- liner and do not pay for the pulp cap as a separate procedure. That
rect pulp cap and a base or liner. Unfortunately, this confusion has being said, every clinician should review the contract to verify the
resulted in inappropriate reporting and thus denials from carriers company’s policies. If it is not spelled out, it is advised to attach a
for indirect pulp cap treatment. This, of course, frustrates dentists written narrative. If payment for the procedure is denied, an ap-
who perform and bill indirect pulp caps correctly. This article will peal is strongly advised.
clarify the differences between direct and indirect pulp caps and
An indirect pulp cap is described in the CDT 2007 glossary as
bases or liners and assist with accurate reporting and accurate
a “procedure in which the nearly exposed pulp is covered with a
reimbursement.
protective dressing to protect the pulp from additional injury and
Bases and Liners to promote healing and repair via formation of secondary dentin.”
Current Dental Terminology (CDT) 2007-08 makes it clear that The descriptor above does not specifically state that the restoration
bases and liners are included in the amalgam and composite resto- should not be performed on the same day as the indirect pulp cap.
ration codes. However, what exactly is a base and what is a liner? CDT 2007 revised code D3120 to clarify “This code is not to
A base is the layer of cement that acts as an insulator and be used for bases and liners when all caries has been removed.”
protective barrier under a dental restoration. It is sometimes Even so, there still appears to be noteworthy confusion surrounding
referred to as an insulating base or an intermediary base. the use of D3120.
A liner is the material placed over the pulpal area of the cav- When performing an indirect pulp cap, most of the caries
ity preparation to soothe irritated or sensitive pulp tissue. is removed. However, a thin layer of caries is left near the pulp.
Medication and a temporary filling are often placed in hopes that
Direct Pulp Caps and Indirect Pulp Caps
the pulp will repair itself by building up a wall of tooth structure
Some dental plans only reimburse direct pulp caps (D3110), between the pulp and the decayed material. The temporary filling
while others only reimburse for indirect pulp caps (D3120). How- is usually removed several months later, and an x-ray is taken to
ever, a recent trend demonstrates that an increasing number of determine if the pulp has healed. If clinically and radiographically
carriers refuse to pay for either procedure because they suspect that the pulp tissue looks fine, the remaining caries is removed, and a
they are often reported incorrectly. A review of direct and indirect permanent restoration is placed.
pulp cap procedures may help clarify how these procedures differ.
At this point, you might be wondering how an indirect pulp
A direct pulp cap is described in the CDT 2007 glossary as a cap is different than a sedative filling. When placing a sedative
“procedure in which the exposed vital pulp is treated with a thera- filling (D2940), the pulp has not been exposed, but all the caries is
peutic material (such as calcium hydroxide) followed with a base removed, the tooth is medicated, and a temporary filling is placed.
and restoration, to promote healing and maintain pulp vitality.”
If you have questions regarding this issue, please contact Dental
This descriptor makes it clear that the purpose of a direct pulp cap
Benefits Manager Mary Essling at (312) 337-2169, ext. 36 or
is to place medication on an exposed pulp and then cover it with a
messling@[Link].
protective barrier (base) and final restoration at the same visit.
New AAPD Member Service
Mary Essling, R.D.H., M.S., joined the AAPD last fall in the new position of Dental Benefits
Manager. Mary has previous experience working on dental and medical procedure coding and
third party insurance matters for both the American Dental Association (from 1994 – 2002) and the
American Society of Plastic Surgeons. She has a Bachelor of Science degree from Marquette Uni-
versity, a master’s in Health Law Policy from DePaul University, and is a registered dental hygienist.
This new service to AAPD members offers hands-on assistance with issues related to third-party
reimbursement and coding. We can help answer your questions regarding dental and medical
coding, effective utilization of dental insurance and provide technical assistance to help resolve any
difficulties that your practice may be having with claims submitted to dental or medical plans.
Please feel free to contact Essling at (312)337-2169, ext. 36, or at messling@[Link].
40 May 2008