Understanding Dental Code D5671

When to Use D5671 dental code

The D5671 dental code is designated for the replacement of all teeth and acrylic on a cast metal framework for a mandibular (lower) removable partial denture. This code is specifically used when the existing partial denture’s teeth and acrylic have worn, fractured, or deteriorated, but the underlying metal framework remains serviceable. It is not appropriate for initial fabrication or when the metal framework also requires replacement; in those cases, refer to codes for new partial dentures. Proper use of D5671 ensures accurate reporting and reimbursement for extensive repairs that restore function and aesthetics without the cost of a full new prosthesis.

Documentation and Clinical Scenarios

Accurate documentation is essential for claim approval when billing D5671. Clinical notes should clearly indicate the condition of the existing prosthesis, including:

• Assessment of the cast metal framework’s integrity
• Details of tooth and acrylic wear, fractures, or loss
• Rationale for replacing all teeth and acrylic rather than spot repairs
• Pre- and post-operative photos (if possible)
• Date of original prosthesis placement and any prior repairs

Common clinical scenarios include patients with long-standing partial dentures experiencing generalized tooth wear, acrylic discoloration, or multiple tooth fractures, but whose metal framework still fits well and is structurally sound.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D5671, follow these best practices:

• Insurance Verification: Confirm the patient’s coverage for major prosthetic repairs and frequency limitations before treatment. Some plans may limit repairs within a certain timeframe after initial placement.
• Preauthorization: Submit a preauthorization with detailed clinical documentation and photos to support medical necessity, reducing the risk of post-treatment denials.
• Claim Submission: Clearly indicate D5671 on the claim form, attach supporting documentation, and include narratives explaining why a full replacement was not needed.
• Explanation of Benefits (EOB) Review: Carefully review EOBs for denial reasons. If denied, prepare a claim appeal with additional documentation, emphasizing the cost-effectiveness and clinical appropriateness of the procedure.

Stay up to date with payer policies, as some may require additional documentation or have specific guidelines for prosthetic repairs versus replacements.

Example Case for D5671

Case Study: A 68-year-old patient presents with a mandibular partial denture placed seven years ago. The metal framework is intact and fits well, but all acrylic teeth are worn and several have fractured. Clinical exam and radiographs confirm that the framework is serviceable. The dental team documents the findings, takes pre-op photos, and submits a preauthorization with a narrative explaining the need for full tooth and acrylic replacement. The insurance approves the claim under D5671, and the patient receives a fully restored partial denture at a lower cost than a new prosthesis.

For related procedures, such as repairs involving only a few teeth or acrylic areas, consider referencing codes like D5670 for maxillary partials or D5611 for repair of resin base, ensuring you select the most appropriate code for each clinical scenario.