D5933
OBTURATOR PROSTHESIS, MODIFICATION
CDT-2024© 2023 American Dental Association
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
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.
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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