It is common for a patient with an existing denture or partial denture to have implants placed. The existing denture or partial dentures are modified to fit the implants placed. This may be modification for the denture to be used as an interim during the healing phase following implant placement. The denture may also be modified with the intention of it being the definitive implant/abutment supported denture (e.g., immediate denture modified after implant placement).
How is modification of a denture following implant placement documented?
CDT includes the code D5875 to document and report the modification of an existing denture or partial denture after implant placement. Let’s review the code language for D5875.
D5875 modification of removable prosthesis following implant surgery
Attachment assemblies are reported using separate codes.
As indicated in the code descriptor, any attachment assemblies are reported separately. This could include but not limited to keeper assemblies (housing) that is luted into the denture and placement of interim abutments. The modification itself could include but is not limited to creating space in the existing denture to align with the implants and to allow for placement of the housing.
What fee should I charge for D5875?
There are various types of modifications that can be made to an existing denture following implant placement. D5875 is designed to report a variety of possible modifications. Therefore, fee data is generally not available. Set your fee based on any expenses incurred and chairside time for the doctor.
Does dental insurance cover code D5875?
Code D5875 is generally not a covered service of dental plans. Only a plan with an implant rider may consider reimbursement for D5875. A review of several dental PPO processing policy manuals, indicate that D5875 is billable to the patient when not covered by the patient’s plan. Some indicate that if implant services are covered by the plan, D5875 is denied as a specialized procedure, billable to the patient.
Billable to the patient may be the actual fee charged for the service or the PPO allowable fee. The fee allowed is subject to any state legislation of fee capping of non-covered services laws and the type of plan and what laws the plan follows. Regardless of reimbursement or lack thereof, always document and report what you do.
When providing implant treatment of any type, whether it be services that lead up to placement of the implant or restoring the implant, many team members find it challenging to know the proper codes that may apply. To increase your coding knowledge regarding implant services, check out our latest addition to our library of webinars-on-demand.