Understanding Dental Code D5867

When to Use D5867 dental code

The D5867 dental code is designated for the replacement of a replaceable part of a semi-precision or precision attachment, specifically the male or female component. This CDT code is used when a patient’s removable prosthesis, such as a partial denture, requires a new attachment part due to wear, damage, or loss of retention. It is important to note that D5867 should not be used for the initial placement of attachments or for repairs unrelated to the replaceable component. Proper use of this code ensures accurate billing and helps avoid claim denials or delays.

Documentation and Clinical Scenarios

Thorough documentation is essential for successful reimbursement when billing D5867. Dental teams should include:

• Clinical notes detailing the reason for replacement (e.g., worn, fractured, or lost attachment component)
• Pre- and post-operative photos if possible, to demonstrate the need and outcome
• Manufacturer details or part numbers of the replaced component
• Patient’s prosthesis history, including date of original placement and any prior repairs

Common clinical scenarios for D5867 include patients reporting looseness of their partial denture, visible wear on the attachment, or loss of retention. In each case, a clear narrative explaining why the replacement is medically necessary will support the claim.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D5867:

• Verify patient benefits before treatment, confirming coverage for prosthesis maintenance and replacement parts.
• Submit supporting documentation with the claim, including clinical notes, photos, and manufacturer information.
• Use precise narratives to explain the necessity of the replacement and why a new attachment is required.
• If denied, review the Explanation of Benefits (EOB) and appeal with additional documentation if needed. Reference the patient’s prosthesis history and clarify that D5867 is not for initial placement.
• Be aware that some plans may limit frequency or require a waiting period for replacement parts. Check policy details during insurance verification.

For related procedures, such as repairs to the prosthesis itself, reference the appropriate CDT code in your documentation and consider linking to articles like repairs to partial dentures for more information.

Example Case for D5867

Case Study: A 67-year-old patient presents with a mandibular partial denture that has become loose. Examination reveals the male component of the precision attachment is worn and no longer provides adequate retention. The dental team documents the issue with intraoral photos and notes, verifies insurance coverage for replacement parts, and submits a claim using D5867. The claim includes a narrative: "Replacement of worn male component of semi-precision attachment due to loss of retention and patient discomfort. Original prosthesis delivered in 2021; no prior replacements." The insurance carrier approves the claim, and the patient’s prosthesis is restored to proper function.

This example highlights the importance of detailed documentation, insurance verification, and clear communication with payers to ensure successful billing for D5867.