Understanding Dental Code D6117

When to Use D6117 dental code

The D6117 dental code is used to report an implant/abutment supported fixed denture for a partially edentulous mandibular arch. This code applies when a patient is missing some, but not all, teeth in the lower jaw, and the treatment plan involves a fixed prosthesis anchored by implants and abutments. D6117 should not be confused with codes for fully edentulous arches or removable prostheses. Always verify the patient’s clinical situation and treatment plan to ensure D6117 is the most accurate code, as proper code selection is crucial for claim acceptance and reimbursement.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing D6117. Your clinical notes should clearly indicate:

• The patient is partially edentulous in the mandibular arch.
• Implants and abutments are being used to support a fixed denture.
• Details of the number and location of implants placed.
• Pre- and post-operative radiographs and photos, if available.
• The rationale for choosing a fixed solution over a removable one.

Common clinical scenarios include patients who have lost several, but not all, lower teeth due to trauma, periodontal disease, or decay, and who desire a stable, non-removable prosthesis. If the patient is missing all teeth in the mandibular arch, refer to the code for a fully edentulous arch.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D6117, follow these best practices:

• Insurance Verification: Before treatment, verify the patient’s plan covers implant-supported fixed dentures and check for any frequency limitations or waiting periods.
• Pre-Authorization: Submit a pre-authorization with supporting documentation (radiographs, narrative, periodontal charting) to clarify medical necessity.
• Claim Submission: Use the exact CDT code (D6117) and ensure all supporting documents are attached. Clearly describe the clinical scenario and why a fixed prosthesis is indicated.
• Explanation of Benefits (EOB) Review: After claim processing, review the EOB for accuracy. If denied, check for missing documentation or coding errors.
• Appeals Process: If necessary, submit a detailed appeal with additional documentation, emphasizing the patient’s partial edentulism and the clinical need for a fixed solution.

Example Case for D6117

Case Study: A 58-year-old patient presents with five missing mandibular teeth due to periodontal disease. After evaluation, the dental team places three implants and fabricates a fixed denture supported by custom abutments. Documentation includes pre-op radiographs, intraoral photos, and a narrative explaining the patient’s preference for a fixed solution due to difficulty adapting to removable dentures. The claim is submitted with D6117, all supporting documents, and a pre-treatment estimate. The insurance carrier approves the claim, and the practice receives prompt reimbursement.

This example highlights the importance of precise documentation, thorough insurance verification, and clear communication with payers to ensure successful billing for D6117.