Fast Facts: Coding Episode 6
[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Coding Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Teresa Duncan, MS.
[Teresa Duncan, MS]
Hello and welcome to another edition of your Coding Fast Facts. Today we're going to talk about D6080 and D6081. Let's go over D6080 first implant maintenance procedures when prosthesis are removed and reinserted, including the cleansing of prosthesis and abutments, and so let's go deeper into the descriptor. This procedure includes active debriding of the implant or implants, an examination of all aspects of the implant system or systems, including the occlusion and stability of the superstructure. The patient is also instructed in thorough daily cleansing of the implant. This is not a per implant code and is indicated for implant supported fixed prosthesis. So that's really important to remember that it is not a per implant code. This is meant for the prosthetics, the removables, or the attached. So either or. Now 6081 is scaling and debridement in the presence of inflammation or mucositis of a single implant, including the cleaning of the implant surfaces without flap entry and closure. This procedure is not performed in conjunction with 1110, 4910 or 4346. That would be respectively, the prophylaxis code, periodontal maintenance code or scaling in the presence of inflammation. These two particular codes we welcomed adding them into the procedure code mix, they were long overdue. 6081 was definitely welcome because we're seeing many more instances of inflammation around implant sites than ever before. And so the code maintenance committee was able to come up with a good code for that so that we can accurately report it. Previously, we really were only reporting it along with either a prophy or with the periodontal maintenance coding and it just wasn't not appropriate. That's how we end up with gaps in the coding system.
When it comes to submission and documentation regarding these particular codes, one thing that you should know, and if you remember back from previous Coding Fast Facts, we did talk about the cleaning of removable prosthetics. Well, 6080 is perfect for use of those codes as well. When you are performing the implant maintenance procedure, remember you are removing it and reinserting it. It does include the cleansing of the prosthesis and abutments. However, you definitely have the ability to bill out for the other ones, which was of course the 9932 through the 9935. Those are the cleaning and inspections of all the removables. There's nothing in the procedure codes that preclude using both of these together, and indeed many offices do.
There is typically no documentation needed for sending in 6080. Typically, if you have the information noted in the chart, the clinical notes do reflect the fact that there are previous placements done. Then that's enough for me, your insurance coordinator to go in there and take a screenshot. 6081 is a different story. I typically have to submit additional information there including the date of placement of the implant and definitely they want radiographs. There's a lot of stuff that they're looking at there including whether or not the implant is healthy, has the rate of progression of disease, has that increase and of course that's where your staging and grading is really good to have incorporated into your clinical notes. There are often times where you will have inflammation around an implant. That code will be denied if it's within two years of placement of that implant. So keep that in mind. Let me repeat myself on that. When you are billing for scaling and debridement in the presence of inflammation of an implant or mucositis of an implant what that means is that within two years the insurance carrier is thinking wait a second, that shouldn't have been inflamed already and so you can expect that most plans will deny benefits for that.
Some of the restrictive plans will actually tell you that you cannot bill for that particular procedure. I would appeal in that situation honestly, every patient has different reasons why their mouths do what they do and there could be some mitigating circumstances as to why you all of a sudden have inflammation. Perhaps it is medications, perhaps they're undergoing some sort of systemic disease process. You never know what it is and so it is worth an appeal if you have an insurance coordinator that's very confident in doing that. When it comes to the 6080 which is again the implant maintenance procedure that's again when you're removing and reinserting the prosthetic, that is typically allowable every three years. If you think about it, that's probably pretty fair but again if you have a patient who has situations where they need it more often because of their individual circumstances Then definitely make sure to appeal and see if you can obtain benefits that way. I hope this has been helpful and thank you so much for listening to the coding Fast Facts.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts - Coding Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at www.dentistrx.com. We'll see you next week for another Fast Fact!