Petition to the American Dental Association and the Arizona Dental Association

We, the undersigned dentists, issue this public statement to affirm fundamental industry standards on coding and to call upon our professional associations to fulfill their core purpose.

Industry Standards We Affirm

The ADA’s CDT Coding Companion establishes that the fundamental rule in all coding situations is “code for what you do.” Accurate reporting of the procedure actually performed, based on full CDT nomenclature and descriptors, is both an ethical and professional obligation.

It is an industry standard that any bundling or mandated inclusion of separate CDT codes must be explicitly stated in the provider agreement before a provider can be required to bundle. Unwritten policies, informal interpretations, or appeals to “community standards” cannot override the written contract or the CDT’s distinct nomenclature.

This standard applies only where state statutes permit such bundling. In states where the bundling of distinct procedures has been made illegal, state law takes priority over any contractual provision. Providers cannot be required to engage in practices that statutes prohibit.

We oppose all forms of bundling, including extra-contractual and unwritten bundling, because it is non-transparent, confusing to patients, and paints providers as coding improperly on claim forms. When distinct procedures are forced into a single code without contractual authority, the clinical record no longer accurately reflects the care delivered, patients cannot readily understand what was performed or billed, and providers are placed in the position of submitting claims that appear inconsistent with the CDT.

We do not regard bundling practices as merely “potentially fraudulent.” We consider such practices absolutely fraudulent. They compel and sway providers to undercode or omit procedures contrary to the CDT and ethical standards, create inaccurate records, and expose the profession to improper claims handling.  Transparency is ethical; bundling practices are non-transparent.

The Proper Role of Dental Associations

Dental associations exist to represent dentists and the profession. A central part of that responsibility is protecting members against improper, non-transparent, or coercive actions by third parties that undermine accurate coding, contractual clarity, and the integrity of the clinical record.

When a payer seeks to enforce unwritten bundling, or terminates a provider for coding according to the CDT rather than engaging in elective bundling not required by the agreement, the associations’ role is clear: stand with the dentist who codes for what was done and oppose practices that are fraudulent.

An illustrative case involves Adobe Hills Dental, PLLC and Health Choice Arizona. The provider sought confirmation of any contractual basis for bundling D9211 (regional block anesthesia). The CDT distinguishes D9211 from local anesthesia codes; the index for local anesthesia does not include D9211. The Coding Companion does not include D9211 with the local anesthesia codes.  A without-cause termination notice was later converted to a with-cause termination citing the coding of D9211. A related Board complaint was dismissed with no violation found. This sequence underscores the need for associations to protect accurate coding and contractual transparency.

Advocacy We Request of the ADA, the AzDA, and All Other State Associations

Because representing dentists against improper and non-transparent practices is fundamental to the purpose of our associations, we call upon the ADA, the AzDA, and all other state associations to stand against the fraudulent behavior of bundling and retaliatory terminations, and to take the following actions:

1.    Public letter from leadership. Issue a clear public statement opposing bundling in all situations.  As part of that statement affirm: that misinterpretations of the CDT that treat distinct procedures as automatically included—absent explicit contractual language—is inappropriate, that bundling must be expressly written in the agreement (where state law permits), and its opposition to retaliatory terminations of providers who code accurately.

2.    Private outreach to Health Choice Arizona and AHCCCS. Engage directly to reinforce that any bundling policy must be expressly annotated in the provider agreement to be binding, that unwritten policies or “community standards” cannot supply a missing term of a provider agreement.  That terminating providers for not engaging in elective bundling is unacceptable.

3.    Public educational materials. Publish articles or guidance affirming “Code for what you do,” stating that ethical coding must not be set aside for bundling, and raising awareness that bundling practices are fraudulent and are opposed by the ADA, the AzDA, and all other state associations.  As part of it accreditation process, educational institutions should be encouraged to inform future practitioners about the ethical standard of "Code for what you do."

Membership Commitment

As signers of this public statement, we expect the Associations to fulfill their purposes by standing against the fraudulent behavior of bundling and retaliatory terminations of providers who code accurately. The ADA’s response will factor into our individual decisions regarding ongoing membership and support.

Conclusion

Accurate coding is a professional obligation. Bundling is fraudulent, non-transparent, and harmful to patients and providers. We ask the ADA, the AzDA, and all other state associations to stand with dentists who code for what they do, to affirm that binding bundling rules must be explicitly written, agreed to, and subordinate to state law.  The ADA and state associations must advocate against practices that encourage inaccurate reporting.

Signature Affirmation

By signing, I affirm the industry standards stated above, including that bundling is fraudulent and terminations of providers for not engaging in elective bundling is inappropriate. I request that the ADA, the AzDA, and all other state associations fulfill their purpose by standing against such practices and undertaking the advocacy actions described. I further affirm that my decision to maintain membership in the ADA will be impacted by how the Association responds to this issue.