Tom Limoli Jr.
The additional laboratory and clinical expenses incurred over and above your crown fee are addressed by Code D6020, Abutment Placement or Substitution: Endosteal Implant.
An abutment is placed to permit fabrication of a dental prosthesis. This procedure may include the removal of a temporary healing cap or replacement with an abutment of an alternate design. The intention of this code is to report this procedure when it is performed by someone other than the dentist who placed the implant.
Depending on the technique- sensitive implant system, you might:
• Expose the cover screw (the healing cap placed with the implant)
• Assess quality of healing in preparation for restorative care
• Replace the healing cap with an abutment to allow the implant to emerge through the gingiva
As the tissue heals, it will conform to the contours of this healing abutment substituted for the original healing cap. Following an appropriate period of healing to obtain the desired prosthetic tissue bed, an abutment is selected to begin the restorative phase of care.
Code D6020 embraces all of the intermediate steps, techniques, and attachments to the submerged implant (D6010) that occur before a final preprosthetic abutment (D6056 or D6057) is attached to the implant. The fee and relative value of D6020 should conform to the desires of the restorative dentist. It may require a second surgical intervention before the final selection of the prefabricated abutment (D6056) or the custom abutment (D6057) is fitted.
The only exception to this scenario occurs when the surgical and prosthetic phases of implantology allow for the direct placement of the crown-retainer to the submerged implant (as in Codes D6065, D6066, and D6069) when no intermediate abutment (D6020) is used. The prostheses are attached directly to the implant with screws or cement.
In terms of reimbursement, if $700 is your fee for a porcelain-to- high-noble metal crown, then D6020 may have a value of 55 to 65 percent or $385 to $455. These fees for D6020 are in addition to the fee for the finished laboratory crown. However, keep in mind that some implant cases require fewer steps and may have a value of only 25 to 35 percent of your fee for the final crown.
Tom Limoli Jr. is the president of Atlanta Dental Consultants and the editor of Dental Insurance Today, a bimonthly publication that addresses third-party reimbursement in the dental office. He also is the author of Dental Insurance and Reimbursement Coding and Claim Submission. He can be contacted by phone at (404) 252-7808. Visit his Web site at www.LIMOLI.com.