Understanding Dental Code D5875

When to Use D5875 dental code

The D5875 dental code is designated for the modification of a removable prosthesis following implant surgery. This CDT code is used when an existing partial or complete denture requires adjustment to accommodate new dental implants. Common scenarios include relining, adding attachments, or altering the prosthesis base to fit around newly placed implants. It is important to note that D5875 should not be used for the fabrication of a new prosthesis, but strictly for modifications to an existing one after implant placement.

Documentation and Clinical Scenarios

Accurate documentation is crucial for successful billing and claim approval. Dental teams should clearly record the following in the patient’s chart:

• Date of implant surgery and location of implants
• Details of the existing prosthesis (type, age, condition)
• Specific modifications performed (e.g., addition of locator attachments, adjustment of base, reinforcement)
• Pre- and post-modification photos, if possible
• Clinical rationale for the modification instead of replacement

Typical clinical scenarios include patients who have recently received implants and need their current denture adapted, or those whose prosthesis requires reinforcement due to changes in oral anatomy post-implant placement.

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D5875, follow these best practices:

• Pre-authorization: Submit a pre-treatment estimate to the payer with supporting documentation, including clinical notes and radiographs.
• Attach supporting evidence: Always include a narrative explaining the necessity of the modification, along with before-and-after images if available.
• Use correct CDT codes: Ensure D5875 is not confused with codes for new prosthesis fabrication, such as complete denture or partial denture codes.
• Review EOBs: Carefully check Explanation of Benefits for denial reasons. If denied, prepare a thorough claim appeal with additional documentation.
• Track AR: Monitor accounts receivable for timely follow-up on outstanding claims related to D5875 services.

Example Case for D5875

Consider a patient who received two mandibular implants to stabilize an existing lower denture. Instead of fabricating a new denture, the dental team modifies the current prosthesis by adding locator attachments and adjusting the fit. The procedure is documented with clinical notes, photos, and a detailed narrative. The claim is submitted with D5875, including all supporting evidence, and a pre-authorization was obtained. The insurance payer approves the claim, and the practice receives timely reimbursement, demonstrating the importance of proper documentation and billing workflow.