Understanding Dental Code D5985

When to Use D5985 dental code

The D5985 dental code is designated for the fabrication of a radiation cone locator, a specialized device used in dental radiology to ensure precise alignment and protection during X-ray procedures. This CDT code is typically utilized when a custom locator is required to optimize patient safety and image accuracy, especially in complex restorative or prosthodontic cases where standard radiographic guides are insufficient. Dental offices should use D5985 when a radiation cone locator is fabricated specifically for a patient, rather than using a generic or reusable device.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing for D5985. Clinical notes should clearly indicate the medical necessity for a custom radiation cone locator, detailing the patient’s specific anatomical or restorative needs. Include information such as:

• The type of radiographic procedure being performed
• Why a standard locator is inadequate
• How the custom locator improves diagnostic accuracy or patient safety

Common scenarios include patients with extensive prosthodontic work, implants, or anatomical variations that complicate standard radiographic positioning. Always attach supporting clinical images and a detailed narrative to the patient’s chart and insurance claim to justify the use of D5985.

Insurance Billing Tips

When submitting claims for D5985, follow these best practices to improve approval rates and minimize denials:

• Pre-authorization: Verify with the patient’s dental insurance whether D5985 is a covered benefit prior to the procedure. Some plans may consider it a non-covered or limited benefit.
• Detailed narratives: Include a thorough explanation of why the radiation cone locator was necessary, referencing clinical findings and treatment plans.
• Correct coding: Double-check that D5985 is the most appropriate code for the service provided. If another code, such as D6190 (radiographic/surgical implant index), is more accurate, use that instead.
• Attachments: Submit supporting documentation, such as radiographs, clinical photos, and chart notes, with the claim to expedite processing.
• Appeals: If a claim is denied, review the Explanation of Benefits (EOB) for the reason, update documentation if needed, and submit a timely appeal with additional supporting evidence.

Example Case for D5985

Consider a patient with multiple dental implants in the posterior maxilla, where standard X-ray guides fail to provide clear visualization due to angulation and anatomical constraints. The dentist fabricates a custom radiation cone locator to ensure precise alignment for periapical radiographs. The clinical notes detail the patient’s implant configuration, the limitations of standard guides, and the improved diagnostic outcomes achieved with the custom locator. The claim is submitted with D5985, accompanied by a narrative, images, and supporting documentation. Insurance reviews the thorough submission and approves the claim, resulting in timely reimbursement and optimal patient care.