Understanding Dental Code D6097

When to Use D6097 dental code

The D6097 dental code is used to report an abutment-supported crown for a dental implant. This CDT code specifically applies when a prosthetic crown is placed on an abutment that is attached to a dental implant, rather than directly to the implant itself. Dental offices should select D6097 when the restoration involves a separate abutment component, distinguishing it from codes used for implant-supported crowns without abutments or for natural tooth crowns. Proper code selection is essential for accurate billing and to avoid claim denials.

Documentation and Clinical Scenarios

To support the use of D6097, dental teams must maintain comprehensive documentation. This includes:

• Detailed clinical notes describing the implant site, abutment placement, and crown restoration.
• Radiographs or intraoral images showing the abutment and crown in place.
• Lab invoices or manufacturer details for the abutment and crown components.

Common clinical scenarios for D6097 include cases where a patient receives an implant, followed by a custom or prefabricated abutment, and then a crown is seated on that abutment. If the crown is attached directly to the implant without an abutment, consider using the appropriate code for implant-supported crowns.

Insurance Billing Tips

Accurate billing for D6097 requires attention to detail and proactive communication with payers. Here are best practices for successful claim submission:

• Verify benefits before treatment to confirm implant and abutment coverage, as some plans have exclusions or waiting periods.
• Submit clear documentation with your claim, including clinical notes, images, and supporting lab invoices.
• Use narrative explanations when necessary, especially if the payer requests additional information about the abutment and crown relationship.
• Review EOBs (Explanation of Benefits) carefully to ensure correct processing and payment. If underpaid or denied, follow up promptly with a claim appeal, referencing your documentation and the CDT code definition.

Staying current with payer policies and CDT code updates is vital for minimizing AR (Accounts Receivable) and maximizing reimbursement.

Example Case for D6097

Consider a patient who lost a molar and received a dental implant. After successful osseointegration, the dentist places a custom abutment onto the implant, then seats a porcelain crown on the abutment. The clinical notes detail the implant site, abutment type, and crown material. Radiographs confirm correct placement. For billing, the office submits D6097 for the abutment-supported crown, along with supporting images and a brief narrative. The insurance claim is processed efficiently, and payment is received without delay, thanks to accurate coding and thorough documentation.

By mastering the use of D6097, dental teams can streamline billing, reduce claim issues, and ensure proper reimbursement for implant restorations involving abutment-supported crowns.