Carol Tekavec, RDH
Last month, we talked about general insurance and ADA parameters regarding implants and implant-supported replacements. This month, we will address some specific codes and how they might be used.
Currently, the actual custom-abutment crown for a fixed bridge (fixed partial-denture retainer), single crown, and full-fixed, denture-abutment prostheses are addressed by codes D6000-D6199. However, pontics are not addressed in these codes. The ADA advises dentists to use implant codes where applicable, and fixed or removable prosthetic codes (D5000-D5899 and D6200-D6999) as needed. The ADA has assigned 24 new codes to the area of implant services. A few of these are:
D6056-Prefabricated Abutment - The ADA description states that this is a "connection to the implant that may require modification from the manufacturer; may be of a cast or machined high-noble metal, or a modification of titanium, titanium alloy, or a ceramically manufactured component." While this code description addresses the fact that some modification may be required before using an abutment in a patient`s case, it is not thought to describe significant modifications.
D6057-Custom Abutment - The ADA description states that this is "a connection to the implant that is fabricated specifically for an individual application or is modified for one application; may be of a cast or machined high-noble metal, or a modification of titanium, titanium alloy, or a ceramically manufactured component." This code is thought to describe cases where the abutment requires extensive and significant nontypical modifications.
D6062-Abutment-Supported Cast Metal Crown (High-Noble Metal) - The ADA description of this code states that this is "a single cast-metal crown restoration that is retained, supported, and stabilized by an abutment on an implant, may be screw-retained or cemented."
D6067-Implant-Supported Metal Crown (Titanium, Titanium Alloy, High-Noble Metal) - This code appears in the CDT-3 with the exact same definition as D6062. These codes should not have the same definition. It is believed that the ADA intended for the D6067 description to state, "A single cast-metal crown restoration that is retained, supported, and stabilized by an implant (instead of `by an abutment on an implant`) may be screw-retained or cemented."
A few codes remain from the previous ADA CDT-2. Two of these are:
D6055-Dental Implant-Supported Connecting Bar - This code is used to describe a connector bar between abutments, typically designed to stabilize a removable overdenture. This code is for a separate service, not inclusive with the placement of the implants and abutments. It also does not include additional overdenture attachments or connectors that might be required.
D6080-Implant-Maintenance Procedures, Including Removal of Prosthesis, Cleansing of Prosthesis, and Abutments and Reinsertion of Prosthesis - The ADA defines this code in part as a "procedure (that) includes a prophylaxis to provide active debriding of the implant and examination of all aspects of the implant system." This code seems to describe the "cleaning" of implants, abutments, and prostheses, but may or may not include a "cleaning" of the natural dentition. For this reason, it may be appropriate to bill for a D1110-Prophylaxis-Adult or a D4910-Periodontal Maintenance Procedure in conjunction with a D6080. However, most plans will exclude a benefit for the D6080 and will pay only what the contract allows for the D1110 and/or D4910.
Pre-authorizing implants is highly recommended and may be a requirement of some patients` plans. A written estimate for the total cost of treatment - regardless of insurance coverage - should be presented, signed by the patient, and retained in the patient`s file.
Carol Tekavec, RDH, is the author of a new insurance-coding manual, co-designer of a dental chart, and a national lecturer with the ADA Seminar Series. Contact her at (800) 548-2164 or visit her Web site at www.steppingstonetosuccess.com.