Understanding Dental Code D5987

When to Use D5987 dental code

The D5987 dental code refers to the commissure splint, a specialized dental appliance used primarily to support and stabilize the corners of the mouth (oral commissures) in patients with compromised oral function. This code is most commonly used in cases involving trauma, surgical defects, or conditions such as facial paralysis that affect the oral commissures. Dental teams should select D5987 when a commissure splint is fabricated and delivered to address these specific clinical needs, ensuring that the patient’s functional and esthetic concerns are managed appropriately.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful billing of D5987. Dental practices should include detailed clinical notes describing the patient’s diagnosis, the functional impairment or defect, and the medical necessity for the commissure splint. Photographs, diagnostic imaging, and a narrative explaining why alternative treatments are not suitable can strengthen the claim. Typical scenarios include:

• Patients with facial nerve paralysis resulting in drooping oral commissures
• Post-surgical reconstruction cases where oral support is needed
• Trauma patients with soft tissue loss at the mouth corners

Ensure that all documentation clearly connects the patient’s condition to the need for the commissure splint, and that the appliance is custom-fabricated for the individual.

Insurance Billing Tips

When billing for D5987, follow these best practices to maximize claim approval and minimize delays:

• Verify coverage: Before treatment, confirm with the patient’s dental and medical insurance whether commissure splints are a covered benefit. Some plans may require pre-authorization.
• Submit comprehensive documentation: Attach clinical notes, photos, and a clear narrative to your claim. Highlight the medical necessity and custom nature of the appliance.
• Use correct CDT coding: Ensure D5987 is listed as the primary procedure code. If other prosthetic or surgical codes are relevant, include them with appropriate documentation and use descriptive anchor text to reference related codes, such as unspecified maxillofacial prosthesis (D5999) when applicable.
• Track EOBs and AR: Monitor Explanation of Benefits (EOBs) for denials or requests for additional information. Follow up promptly on outstanding Accounts Receivable (AR) and be prepared to submit claim appeals with supplemental documentation if needed.

Example Case for D5987

Consider a patient who has undergone surgical removal of a tumor affecting the left oral commissure. The dental team documents the surgical defect, takes pre- and post-operative photos, and fabricates a custom commissure splint to restore oral function and esthetics. The office verifies insurance coverage, submits the claim with detailed notes and images, and receives approval after one round of additional information requested by the insurer. This real-world scenario highlights the importance of thorough documentation, proactive insurance verification, and diligent follow-up in successfully billing D5987.

By understanding the clinical indications and billing requirements for D5987, dental practices can ensure appropriate reimbursement while delivering optimal patient care.