Thursday Troubleshooter: Code D6080 denied, resubmit as D1110?
Coding for dental practices can be confusing, especially when the office staff believe they've submitted the right code and the insurance company rejects it.
Do you have a problem or concern on the job? Sometimes people are just too close to a situation to solve something themselves. Share your concerns with Team Troubleshooter, and the experts will examine the issues and provide guidance. Send questions to email@example.com.
QUESTION: If an insurance company denies the cleaning of implants with code D6080 and denture, can we resubmit it as code D1110?
ANSWER FROM PATTI DIGANGI, author of the DentalCodeology series of books:
This question is important and I would love to give a simple response, but I don't have enough information to do so. The coding for implant maintenance and disease treatment has changed some with the recent CDT updates. Yet there are still not enough codes. I’ve asked a group of people from the Dental Codeologist member network to work on this exact issue.
In my recent book, CDT 2018 Shifts, I discuss submitting for care when implants are involved this way.
Implant services D6081 confusion and changes
D6081 is similar to D4346 in that the descriptions for both codes state they cannot be submitted with other codes:
- D4346—Should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.
- D6081—This procedure is not performed in conjunction with D1110, D4910, or D4346.
When D6081was added to CDT 2017, D4346 did not exist. For clarity, D4346 was added.
Important implant maintenance questions
For clarity, it is important to look at the complete CDT 2018 entries:
- D6080—Implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prostheses and abutments.
This procedure includes active debriding of the implants and examination of all aspects of the implant systems, including the occlusion and stability of the superstructure. Patients are also instructed to thoroughly clean the implants daily. This is not a per implant code, and is indicated for implant-supported fixed prostheses.
- D6081—Scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surfaces, without flap entry and closure.
This procedure is not performed in conjunction with D1110, D4910, or D4346.
Here are some additional questions that I am often asked.
Question: For patients with all-on-four fixed prosthetics, does D6081 need to be used separately for each implant or can it be used for the arch?
Answer: For scaling and debridement of the implants, use D6081. You should submit for each implant since this is a per implant code.
Question: If D6081 cannot be combined with D1110, D4910, or D4346, can D6080 be combined with these codes?
Answer: As noted from the codes above, D6081 has specific language that bars its submission with other specific codes. This language does not appear with D6080. Yet the D6080 code calls for the removal of the prostheses.
Implant maintenance (D6080) can be submitted for the same date of service that the patient receives a prophylaxis (D1110) or periodontal maintenance (D4910). This is because the implant maintenance procedure does not include services rendered to natural teeth in the patient’s mouth.
Question: Is there a preventive code for maintaining implants if the patient does not have peri-implantitis or peri-mucositis?
Answer: This question becomes how the peri-implantitis or peri-mucositis condition is determined. Many of our diagnostic modalities are to measure after damage has occurred. Using a preventive code makes little sense when damage has already occurred because the care being provided is maintenance. This is where coding can be a challenge based on previous history, recordkeeping, and more. Does this case qualify under the D4910 code?
Part of the definition states, “This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements.”
Were the teeth lost due to periodontal disease? Were the implants part of periodontal therapy? It can be argued that D1110 is not accurate. The definition states, “Removal of plaque, calculus, and stains from the tooth structure …” An implant and implant prosthetic is not a tooth.
Is it an implant-supported denture? There are codes for the cleaning of dentures:
- D9932—Cleaning and inspection of removable complete denture, maxillary
- D9993—Cleaning and inspection of removable complete denture, mandibular
- D9934—Cleaning and inspection of removable partial denture, maxillary
- D9935—Cleaning and inspection of removable partial denture, mandibular
Are the implants healthy or is there mucositis or peri-implantitis? What is the diagnosis?
Can it be resubmitted under D1110? We must code accurately for the treatment rendered, so is D1110 accurate?
I know this is a lot of information. Feel free to email me for any clarification. It’s our duty as dental professionals to code as accurately as we possibly can.
Don't be shy! If YOU have a tough issue in your dental office that you would like addressed, send it to firstname.lastname@example.org for the experts to answer. Remember, you'll be helping others who share the same issue. Responses will come from various dental consultants, as well as other experts in the areas of human resources, coding, front office management, and more. These folks will assist dental professionals with their various issues on DentistryIQ because they're very familiar with the tough challenges day-to-day practice can bring. All inquiries will be answered anonymously each Thursday here on DIQ.
Dental hygienist upset at patient claims she's inflicting pain
Should dental team member write up peer who refuses to listen?
How much notice should hygienist give dentist about semi-retirement?