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

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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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