Understanding Dental Code D5923

When to Use D5923 dental code

The D5923 dental code is designated for an ocular prosthesis, interim. This CDT code is used when a patient requires a temporary artificial eye, typically following enucleation (removal of the eye) or severe trauma. The interim prosthesis serves as a placeholder while tissues heal or until a definitive ocular prosthesis can be fabricated. Dental offices should use D5923 only when providing a temporary solution, not for the final or permanent prosthesis, which is billed under a different code. Proper code selection ensures accurate claims processing and compliance with insurance requirements.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing D5923. The clinical notes should clearly state the reason for the interim prosthesis, such as recent surgery, trauma, or infection. Include the date of enucleation or injury, a description of the patient’s healing status, and the rationale for choosing an interim device. Photographs, operative reports, and referral letters from ophthalmologists can strengthen the claim. Common scenarios include:

• Immediate post-surgical placement after eye removal
• Temporary restoration following trauma with significant tissue loss
• Situations where healing must occur before a permanent prosthesis is made

Be sure to update the patient’s chart with progress notes and planned follow-up for the definitive prosthesis.

Insurance Billing Tips

Billing for D5923 requires attention to detail to avoid denials and delays. Here are best practices for successful claims:

• Verify coverage: Confirm with the patient’s dental and medical insurance whether interim ocular prostheses are covered, as some plans may consider this a medical benefit.
• Pre-authorization: Obtain pre-authorization or pre-determination when possible, submitting clinical documentation and justification for the interim device.
• Submit supporting documents: Attach operative notes, photos, and referral letters to the claim. This demonstrates medical necessity and expedites approval.
• Use correct coding: Ensure D5923 is not confused with codes for permanent prostheses, such as D5922 (definitive ocular prosthesis).
• Track EOBs: Review Explanation of Benefits (EOBs) promptly to address any denials or requests for additional information. If denied, follow up with a timely claim appeal including further documentation if needed.

Example Case for D5923

Consider a patient who underwent enucleation due to ocular melanoma. The oral and maxillofacial prosthodontist places an interim ocular prosthesis immediately post-surgery to maintain facial contour and support healing. The dental billing team verifies insurance coverage, obtains pre-authorization, and submits the claim with operative notes and a referral letter from the ophthalmologist. The claim is approved, and the patient returns in three months for evaluation and fabrication of the definitive prosthesis, which will be billed under D5922. This workflow ensures proper reimbursement and continuity of care.