Understanding Dental Code D5711

When to Use D5711 dental code

The D5711 dental code is used for rebasing a complete mandibular (lower) denture. Rebasing involves replacing the entire acrylic denture base material without changing the existing denture teeth. This procedure is typically indicated when the denture base has become worn, cracked, or ill-fitting, but the teeth remain in good condition. Common scenarios include significant tissue changes, long-term wear, or damage to the base that cannot be repaired with a simple reline.

Documentation and Clinical Scenarios

Proper documentation is essential for successful claim approval and compliance. When billing for D5711, ensure the patient’s clinical record includes:

• Detailed notes describing the condition of the existing denture and the reason for rebasing (e.g., base fracture, loss of fit, tissue changes).
• Pre-operative and post-operative photos, if possible, to support the necessity of the procedure.
• Chart entries specifying that only the base is being replaced, not the teeth.
• Date of original denture delivery and any previous repairs or relines.

Common clinical scenarios include patients with a well-maintained denture who experience a cracked base, or those with significant resorption of the mandibular ridge causing poor fit, but whose denture teeth are still serviceable.

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D5711:

• Verify benefits: Confirm with the payer if rebasing is covered, frequency limitations, and any waiting periods.
• Submit supporting documentation: Attach clinical notes, photos, and a narrative explaining why rebasing is necessary instead of a new denture or a simple reline (see D5751 for reline procedures).
• Include original denture date: Many payers require the date the original denture was delivered to determine eligibility.
• Appeal if denied: If the claim is denied, review the Explanation of Benefits (EOB) for reasons and submit an appeal with additional documentation if needed.
• Coordinate with patient: Discuss potential out-of-pocket costs if the payer has frequency or replacement restrictions.

Example Case for D5711

A 68-year-old patient presents with a complete mandibular denture delivered five years ago. The denture teeth are in good condition, but the acrylic base has fractured and no longer fits the patient’s arch due to tissue changes. After evaluating the denture, the dentist determines that rebasing is the most appropriate solution. The clinical team documents the fracture, takes pre-operative photos, and notes the original delivery date. The claim for D5711 is submitted with a detailed narrative and supporting images. The insurance payer approves the claim, and the patient receives a newly rebased denture base, restoring comfort and function without the cost of a full replacement.