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D5933

OBTURATOR PROSTHESIS, MODIFICATION

CDT-2024
Warning
It is misleading to report “implant type” crowns D60XX as “routine” individual crowns D27XXfor natural teeth, solely to increase reimbursement. This may be considered a fraudulent act. Report exactly what you do rather than what may gain a higher reimbursement.
Caution
reports an “abutment supported” crown. It is an error to report an “implant supported” single screw-retained tooth prosthesis when the crown is anchored to an abutment.
Match
reports a porcelain/ceramic crown anchored to an implant abutment. This code describes an “abutment supported” crown anchored over either a prefabricated () or custom abutment (). is not attached directly to the implant body but is instead cemented to a separate abutment.
If an alternative benefit is provided or if covered by an implant policy rider, then reimbursement for “implant type” crowns is typically subject to the five to ten year limitation period.
Age, waiting periods, missing tooth clauses, or other limitations may also apply.
Ask for the alternate benefit of a similar material type crown if there is no implant coverage.
Reporting the incorrect type of material (ceramic,high noble, noble, base, etc.) used in fabricating the crown is a common coding error. Be careful to report the correct code based on the material classification. Document the correct material used in the crown on the claim form as represented in the treatment plan, the lab prescription, and the documentation from the lab. Following this protocol should eliminate reporting errors.
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