Billing major procedures of any kind can be very challenging. Everyone has different levels of experience in their billing skills. If you have ever been confused by the multitude of codes for major restorative procedures, here are some for dentures. This De-Coding the Code article gives you the most frequently used bridge codes and some guidelines for when to use these particular codes.
D6191 Semi-Precision Abutment-Placement – This procedure is the initial placement, or replacement, of a semi-precision abutment on the implant body.
D6191 describes the initial placement or replacement of a semi-precision abutment on the implant body. This is the male piece of the locator.
For a patient with a complete maxillary or mandibular natural tooth overdenture (D5863 or D5865), see (D5862 to report a precision attachment).
D5862 Precision Attachment, by Report – Each pair of (male and female) components is one precision attachment. Describe the type of attachment used.
Semi-precision abutments may be reimbursed if the patient’s insurance has implant coverage and there is adequate justification for using the semi-precision abutment.
D6192 Semi-Precision-Placement – This procedure involves the luting of the initial or replacement, semi-precision attachment to the removable prosthesis.
D6192 reports the female keeper assembly (attachment) luted into the removable prosthesis.
For a patient with a complete maxillary or mandibular natural tooth overdenture (D5863 or D5865), see (D5862 to report a precision attachment.
Bill both D6191 and D6192 when separate abutment and locator assemblies are used with removable implant prosthesis.
D6056 Prefabricated Abutment-Includes Modification and Placement
Do not bill D6056 in conjunction with an abutment-supported removable overdenture (D6110, D6111, D6112, and D6113). See D6191 for abutment and D6192 for female attachment keeper assembly placement in the removable implant overdenture.
Charge separately for a prefabricated implant abutment (D6056) when associated with an abutment-supported crown.
D6930 Re-cement or re-bond fixed partial denture
Some carriers will not cover a re-cementation or re-bonding provided by the same dentist within 6 to 12 months of delivery. If re-cementation or re-bonding is needed within 6-12 months of delivery, the service is considered part of the initial procedure.
Re-cementation or re-bonding of a bridge may not be subject to the typical limitation period if re-cemented or re-bonded by a different dentist in another office.
Once a diagnosis and treatment plan is identified, choosing the correct codes will help verify how much of an extensive plan is covered by the patient’s insurance. Giving an explanation and estimation of the insurance portion and the patient portion, when your patient wants one is a positive step toward case acceptance.
Kathleen Johnson is a dental practice management and transition consultant with more than 35 years in the dental field.