Thursday Troubleshooter: What is final restoration in implant access hole code?

This dental staff member needs help with the correct coding for final restoration in an implant access hole. It can be elusive, but this explanation from a coding expert should help.

Aug 9th, 2018
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Nearly everyone has problems and concerns on the job, and sometimes you're just too close to a situation to solve something yourself. Share your concerns with Team Troubleshooter, and the experts will examine the issues and provide guidance. Send questions to megk@pennwell.com.

QUESTION: I am looking for a code for final restoration in implant access hole. If our practice bills out as a buildup or a filling the insurance will deny because there is no tooth there.

ANSWER FROM PATTI DIGANGI, coauthor of the book series DentalCodeology:
A proposal came before the Code Maintenance Committee (CMC) last year. It sounds like what you’re looking for.

The submission of a code for CDT 2018 was submitted as: blocking out an implant restorative access hole. The description was, “An access hole in an existing screw-retained crown may need to be blocked out using composite or other restorative material (not to be combined with any other implant-related procedure)."

The CMC voted that a specific code was not needed. Their stated reason was, “The CMC found that the submission documentation did not establish a need for a new CDT code entry, and that the procedure as described is part of an implant crown procedure. Sealing the access hole is a later step in the overall procedure, that is appropriately documented with the applicable existing implant crown CDT code.”

At the same time, there is always a code. In this case, the code available is D6199 unspecified implant procedure by report.Use for procedure that is not adequately described by a code. Describe procedure.

Any "by report" code requires a narrative. The narrative should include:
• Clinical condition of the oral cavity
• Description of the procedure performed
• Specific reasons why the procedure was needed, or why extra time or material was needed
• How new technology enabled delivery

Will that mean there is coverage? Not necessarily. Coverage is a contract.

In Chapter 8 of the CDT 2018 Companion, Linda Vidone, DMD, wrote, “Reimbursement for surgical implant placement and restorations varies among dental benefit plans. Often when the surgical implant is not a benefit, the implant restorations are reimbursed as an alternative benefit. Even if a patient has an implant rider, there still may be limitations.”

To stay current on dental coding, I recommend purchasing both CDT 2018 and CDT 2018 Companion, setting up a team meeting to review coding updates, and getting an annual membership as a dental codeologist.

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