Understanding Dental Code D6086

When to Use D6086 dental code

The D6086 dental code is designated for a single implant-supported porcelain/ceramic crown. This CDT code should be used when a patient receives a crown that is directly attached to a dental implant, rather than a natural tooth. It is important to distinguish D6086 from other implant and crown codes, such as D6065 (implant-supported porcelain fused to metal crown) or D6057 (custom abutment), to ensure accurate billing and claims processing. Use D6086 only when the restoration is a single, all-ceramic or porcelain crown supported by an implant abutment.

Documentation and Clinical Scenarios

Proper documentation is crucial for successful reimbursement of D6086. Clinical notes should clearly indicate:

• The presence and location of the dental implant
• That the restoration is a single crown, not a bridge or multi-unit prosthesis
• The material used (porcelain/ceramic only)
• Attachment to an implant abutment (not a natural tooth)

Common clinical scenarios include replacing a single missing tooth with an implant and restoring it with a porcelain crown. Be sure to include pre- and post-op radiographs, intraoral photos, and a narrative explaining the necessity of the implant-supported crown. This level of detail supports claim approval and reduces the risk of denials.

Insurance Billing Tips

Billing for D6086 requires attention to detail. Here are actionable steps for maximizing claim success:

1. Verify insurance coverage before treatment, as many plans have specific exclusions or waiting periods for implants and related restorations.
2. Submit comprehensive documentation with the claim, including clinical notes, radiographs, and a detailed narrative.
3. Use the correct CDT code for each component of the implant restoration. For example, if a custom abutment is placed, bill it separately using D6057.
4. Review the Explanation of Benefits (EOB) carefully. If the claim is denied, check for missing documentation or coding errors, and be prepared to submit a claim appeal with additional supporting information.
5. Track accounts receivable (AR) to ensure timely follow-up on outstanding claims and minimize delays in reimbursement.

Example Case for D6086

A 52-year-old patient presents with a missing upper right first molar. After thorough evaluation, the dentist places a dental implant. Three months later, the site is ready for restoration. The dentist fabricates and delivers a porcelain crown, which is attached to the implant abutment. The clinical notes specify the use of a porcelain/ceramic crown, and radiographs confirm proper placement. The office bills D6086 for the crown and D6057 for the custom abutment. Documentation is submitted with the claim, and the insurance carrier approves payment after reviewing the detailed narrative and images.

This example highlights the importance of correct code selection, thorough documentation, and proactive insurance communication for successful reimbursement of D6086.