Tips that will help you and your claims submission process be successful
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- Updated:
- December 2022
- Topic:
- 3Submitting a Claim
Oftentimes in the dental office we encounter scenarios where we are unsure of the correct coding to submit to insurance on the claim form. Coding for procedures involving implants can be particularly confusing, as there are so many different treatment options. Learning how to properly code for various implant restorations and associated procedures, such as implant dentures, flippers, implants that are periodontally involved, or the replacement of o-rings or retention caps, can make the workflow go much smoother.
Here are some recent Q & A’s from Practice Booster’s support call center, many of which regard implant coding. We know these tips will help you and your claims submission process be successful.
Question 1:
How do you properly code for a patient who has an upper removable denture (with no implants) that we inspect and clean, and a lower removable overdenture with four implants? We inspect, clean, and replace the four retention caps. We purchase the replacement retention caps and assume there is a charge to the patient.
Answer:
Cleaning and inspecting the upper complete denture would be reported using D9932 cleaning and inspection of a removable complete denture, maxillary. Cleaning and inspecting the lower overdenture would be reported using D9933. Replacing the retention caps would be reported as D6091 replacement of replaceable part of semi-precision or precision attachment of implant/abutment supported prosthesis, per attachment for each.
Question 2:
A patient has an upper removable denture with four implants. He has natural teeth on the mandibular which require periodontal maintenance. Should we code out D9932 for the upper? How do we code the lower?
Answer:
D9932 would be the appropriate code for cleaning and the upper, removable prosthesis. The mandibular could be reported using the normal perio maintenance code, D4910, which includes cleaning any associated implant crowns. The best strategy would be to charge the full fee for D4910 and no charge for cleaning the upper denture.
Question 3:
A patient has an implant supported fixed upper denture, which the doctor has to remove, inspect, and clean. He then has to put resin back in the screw access holes once everything is completed. How do we report this procedure?
Answer:
D6080 implant maintenance procedures, when prostheses are removed and reinserted, including cleansing of prostheses and abutments is the code to disassemble, clean, and reassemble a fixed implant supported restoration. The sealing of the screw access holes is considered an integral part of the D6080 and cannot be reported separately.
Question 4:
Can you code D4346 if 4mm pockets are only around 1-3 teeth? Would you then only treat necessary teeth and then return for a prophy schedule? Can this be diagnosed at periodic exam after prophy....then schedule back for D4346 asap ...then return to 6 month prophy schedule?
Answer:
D4346 means moderate to severe gingival inflammation with NO bone loss. If you have bone loss and 4mm or deeper probings for 1-3 teeth, then that is SRP, different from D4346. D4346 is diagnosed when the patient is initially seen. It would not be appropriate to do D1110 followed by D4346 shortly thereafter. D4346 is done upfront and then followed by a prophy several weeks later. Read D4346 for a full description in the Dental Coding With Confidence book or online in the Code Advisor suite.
Question 5:
We are finding insurance will not cover a limited exam and palliative code on the same visit. What other code can we use for the doctor?
Answer:
First, it is completely permissible to bill for D0140 and D9110 together. That said, some insurance plans do not permit reimbursement for both on the same service date. It is plan dependent, as outlined in their policy processing manual. Just because there is a code does not mean it is always payable.
Question 6:
6: Which code would we use for de-bracketing a patient which another provider placed?
Answer:
If the treatment is not fully completed, the code for de-bracketing a patient which another provider placed is D8695 removal of fixed orthodontic appliances for reasons other than completion of treatment. The narrative should establish the reason for the premature removal of the appliances and indicate that the dentist who removed the appliances is not the dentist that directed treatment. Photos may be helpful in receiving reimbursement.
If treatment was completed and a different provider other than the provider who placed the active appliances removes the active appliances, report D8680orthodontic retention (removal of appliances, construction and placement of retainer(s) and submit a brief narrative describing the situation. D8680 might be reimbursed if the orthodontic lifetime benefits have not been exhausted.
Follow our blog for more Q & A’s, and improve your bottom line when you code accurately! Practice Booster also offers consulting services, which can help you maximize your legitimate dental insurance reimbursements.
