Understanding Dental Code D6113

When to Use D6113 dental code

The D6113 dental code is designated for an implant/abutment supported removable denture for a partially edentulous mandibular arch. This CDT code should be used when a patient is missing some, but not all, teeth in the lower jaw, and the treatment plan calls for a removable partial denture that is supported by dental implants or abutments. It is essential to distinguish D6113 from codes for fully edentulous arches or fixed prosthetics. Proper code selection ensures accurate claim submission and reimbursement.

Documentation and Clinical Scenarios

Accurate documentation is key for successful billing and claim approval. When using D6113, ensure the clinical notes clearly indicate:

• The arch being treated (mandibular/lower jaw)
• The partial edentulism status (which teeth are missing and which remain)
• The use of dental implants or abutments as support for the removable denture
• Pre-operative radiographs and treatment planning records
• Detailed narrative describing the necessity for implant support versus conventional removable partial dentures

Common clinical scenarios include patients with significant tooth loss in the lower arch who have sufficient bone for implant placement, but who are not candidates for a fixed prosthesis due to anatomical, financial, or personal preferences.

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D6113:

• Verify benefits before treatment: Confirm with the payer that implant-supported removable partial dentures are a covered benefit and clarify any frequency limitations or waiting periods.
• Submit comprehensive documentation: Attach pre-op and post-op radiographs, periodontal charting, and a detailed narrative explaining the clinical rationale for implant support.
• Use correct attachments: Include implant brand, location, and abutment details as required by the payer.
• Monitor EOBs (Explanation of Benefits) for payment accuracy and watch for bundling with other procedures, such as implant placement (D6010) or abutment placement (D6056).
• Appeal denials promptly: If claims are denied, review the payer’s policy, supply additional documentation, and submit a clear appeal letter referencing the clinical necessity and supporting evidence.

Example Case for D6113

Case: A 62-year-old patient presents with multiple missing teeth in the lower arch but retains several anterior teeth. After evaluation, the dental team recommends a removable partial denture supported by two strategically placed implants to enhance retention and stability. The clinical notes document the patient’s partial edentulism, the locations of the implants, and the rationale for choosing a removable prosthesis over a fixed option. The claim is submitted with D6113, accompanied by radiographs, a narrative, and implant details. The insurance carrier approves the claim after reviewing the comprehensive documentation, and the practice receives timely reimbursement.

This example highlights the importance of using the correct CDT code, thorough documentation, and proactive communication with payers to ensure successful outcomes for both the patient and the dental practice.