CDT Codes For Dental Implant And Dental Restoration Procedures

In today’s world, getting full reimbursements from insurance providers has become difficult. One of the main reasons for this is constantly fluctuating dental insurance guidelines. So, it is imperative to correctly document each step of dental implant procedures to get the highest possible remuneration.

Also, dental procedures are eligible for reimbursement when they fulfill the criteria of medical necessity. For instance, a dental procedure done to rectify the ability to chew. Some dental insurance policies consider an implant as a cosmetic procedure.

However, some plans cover the restorative and surgical elements of dental implants. This is why practices must opt for reliable eligibility verification or breakdown of benefits to minimize the chances of claim denials. They can also outsource dental billing to a leading Revenue Cycle Management company to ease their billing and revenue concerns.

Lastly, doctors/physicians, in-house staff, third-party billers, or anyone responsible for coding, claim creation, and submission must be on their toes and use accurate CDT codes for dental implant procedures to enhance the chances of claim approval and reimbursements.

Common CDT Codes for Dental Implant Procedures

Here are some of the commonly used dental implant procedures approved by the American Dental Association (ADA) and the codes to classify these services. Getting acquainted with these codes is important to ensure error-free documentation and correct documentation.

Dental Implant Services

Surgical Implant Procedure Codes

Other Implant Services

Useful Information Regarding Correct Dental Implant Procedures and Codes

It is important for dentists, their in-house staff or third-party medical billing services providers to be aware of the correct codes and insurance documentation guidelines to ensure maximum reimbursements against services offered.

Dental practices and people responsible for coding and documentation must stay updated with the CDT codes and periodical changes, as even the tiniest mistakes lead to claim denials. 

Here’s some handy information that will surely benefit you in error-free claim creation and submission.

How to Code for Bone Grafts During Implant Placement?

Use the code D7953 for a bone graft to preserve the ridge when placing an implant. In case the dentist performs another procedure to replace bone graft, use the code D7950 for osseous, osteoperiosteal, or cartilage graft related to mandible or maxilla.

The Correct Code for Osseointegration

Osseointegration is usually part of the implant placement process (D6010). However, if extra steps are needed, the dental practitioner may use D6013 for placing a mini implant or D6052 for attaching a semi-precision abutment.

Correct Codes When Graft Collection and Placement Are Performed Separately

In such a situation, we advise you to use D7292 for placement of a temporary anchorage device for orthodontic purposes. It also includes device removal. When it comes to graft placement, based on specific procedures, you should use D7953, D4263, or D7950. 

How to Code for Bone Grafts During Tooth/Implant Extraction?

In such a case where you have to document a bone replacement graft for ridge preservation – per site, you must document D7953. However, if there is a requirement for additional grafting, you can use D4263 or D4264 for bone replacement grafts in the same surgical site.

How to Code for Implant-Supported Prosthesis?

For implant-supported ceramic/porcelain crowns, you should use D6065. However, if it is implant-supported porcelain fused to a metal crown, use D6066. If the treatment entails an implant-supported metal crown, the appropriate code to use is D6067. D6110 will classify full arch prosthesis and D6111 for implant/abutment-supported removable dentures.

Dental Restoration Procedures and their CDT Codes

Also known as restorative dentistry, dental restorations are procedures done precisely to repair or replace a tooth. These include missing tooth structure due to decay, deterioration, or tooth fracture. Dental restoration services are known to rectify these issues with ease.

The main services included in restorative dentistry are:

1.       Fillings
2.       Crowns
3.       Implants
4.       Bridges
5.       Dentures
6.       Root Canals

These corrective services are provided to achieve multiple purposes like restoring the functionality of the teeth, improving the teeth’ appearance or enhancing their cosmetic appeal, preserving bone density, eliminating pain caused by infection and dealing with dental issues.

Let’s now tell you a bit about these dental restorations and their CDT codes.

Fillings

This tooth restoration process involves the filling of cavities with an amalgam or resin-based material. It may be important to know that bacteria or poor oral hygiene are responsible for tooth decay and cavities. If a patient doesn’t get it checked timely, chances are that the bacterial infection will spread resulting in structural issues. If such a situation arises, the treatment will require complex dental services.

The filling procedure demands the dentist to extract the decayed tooth part and fill it using a composite material. The filling will stop the bacteria from entering the tooth and infecting it. Fillings are made using expensive metals like gold and silver amalgam.

Based on the condition, the dentist may use composite resin fillings made of tooth-colored plastic or glass material. Also, ceramic and porcelain fillings are more durable than composite resin fillings.

CDT Codes for Fillings

Crowns

It is one of the famous tooth restoration methods going around. The process involves fixing a tooth-shaped cap over a tooth to help restore its size, shape, and strength. It also helps to enhance tooth appearance. 

In case the filling or tooth shows signs of fracture, dentists recommend the crown procedure to cover multiple decays on the same tooth, a tooth treated for root canal, or to support a tooth that has undergone an extensive restoration process.

Dentists also opt for other options, like holding a bridge or covering a dental implant. It strengthens the tooth, increases the aesthetic appeal, and also helps restore the natural color. 

To restore a tooth’s size, shape, and strength, the process of placing the crown on the top requires shaving down the top part of the tooth. Different metals are used in its manufacturing. These include metal alloys, ceramic, porcelain, porcelain fused metal, or composite resin.

Bridge

As the name implies, dental bridges are used to replace the missing place between two or more teeth. Whether a patient is missing one tooth or multiple teeth, a bridge ‘bridges the gap’ to give you a confident smile. A bridge is made of crowns and artificial teeth placed over the natural teeth on both sides of the gap and to fill the space in between.

Based on the requirements, dentists can opt for custom bridges to match the size, color, and space between the teeth. They’re made of gold, porcelain, metal alloys or a combination of these. Dental bridges are beneficial as they help restore chewing function, a confident smile, and overall appearance. They also play a vital part in improving oral health.

We’ve mentioned the CDT Codes for dental restoration procedures involving Crowns and Bridges.

Implants

Dental implants are replacement tooth roots. Dentists recommend this dental restoration procedure to patients suffering from severe decay, damage, and missing teeth. However, implants are only for those patients who have healthy gums and enough bone underneath to hold and sustain the implant.

There are two common methods used for implant restoration – screw-retained and cemented. As compared to cemented implants, screw-retained restoration is the preferred option as it can be repaired easily if the crown gets fractured. There is much more to these implants, as they serve as anchors for dentures and bridges.

Following are the CDT Codes for implants.

Dentures

If a patient isn’t left with healthy and properly functioning teeth in the mouth, the best replacement option they have is dentures. There could be multiple reasons for unhealthy or missing teeth. These include tooth decay, gum disease, or any injury. The composition of dentures is based on acrylic resin, and metal can also be infused – in the form of attachments – to strengthen the structure.

Normally, there are three main types of dentures i.e., conventional, immediate, and overdenture. Complete dentures replace all the teeth inside the mouth. Conversely, partial dentures are helpful when someone has a few teeth in place.

Two other types of dentures are also known as removable and implant dentures. Removable ones can be attached to the gums using suction, while the implant dentures are attached to the few dental implants in the jaw.

CDT Codes for Dentures

How to Code for Complex Cases, i.e., Multiple Procedures?

It is important to keep yourself updated with the latest codes and CDT changes. Also, when a situation involving complex cases and multiple procedures arises, start by dividing the treatment into individual procedures. Now, add code for each component involved.

Ensure thorough documentation and description to justify medical condition, procedure performed, and codes used. Complete documentation of every component helps to ensure proper reimbursement against services provided.

Final Words

Lastly, dental practices, practitioners, and dental billing services providers must undergo continuous training to stay updated on the recent CDT codes. It helps to file claims correctly. Staying proactive is the key to success.

It helps maintain a smooth revenue flow, save time, and provide exceptional care to patients. Any change in code, modifier, or even a minute error may result in severe consequences like claim denials and even lawsuits. You can also consider outsourcing billing to a reliable dental billing company like DRG.