Understanding Dental Code D6190

When to Use D6190 dental code

The D6190 dental code is designated for the fabrication and use of a radiographic or surgical implant index, which is reported separately from the actual implant placement. This code should be used when a dentist or specialist creates a custom guide or index to assist with the precise placement of dental implants. The index may be used for radiographic evaluation, surgical planning, or both, and is essential in cases where accuracy is critical—such as in complex implant cases, multiple implant placements, or when anatomical structures require careful navigation.

Documentation and Clinical Scenarios

Proper documentation is key to successful reimbursement for D6190. Clinical notes should clearly describe the need for the index, the process of its fabrication, and its intended use (radiographic, surgical, or both). Attach diagnostic images (such as CBCT scans or panoramic x-rays) and detailed narratives that justify the necessity of the index. Common scenarios include:

• Patients with limited bone volume or proximity to vital anatomical structures.
• Cases involving multiple implants requiring precise angulation and spacing.
• Situations where a surgical guide is needed for flapless implant placement.

Always ensure that the provider’s clinical notes match the submitted claim and include all supporting documentation to minimize delays or denials.

Insurance Billing Tips

Billing for D6190 requires attention to detail. Here are best practices to maximize claim acceptance:

• Pre-authorization: Submit a pre-authorization request with supporting documentation, including radiographs and a detailed narrative, to verify coverage before proceeding.
• Itemized Claims: Clearly separate the D6190 charge from other implant-related procedures (such as implant placement or abutment procedures), as bundling may result in denials.
• Appeal Denials: If denied, review the Explanation of Benefits (EOB) for the reason, and submit a claim appeal with additional documentation or clarification as needed.
• Verify Coverage: Not all dental plans cover D6190, so always verify benefits and limitations with the payer before treatment.

Accurate CDT coding and thorough documentation are essential for successful reimbursement and compliance.

Example Case for D6190

Case Example: A patient presents for the replacement of two missing mandibular molars. Due to the proximity of the inferior alveolar nerve and limited bone height, the dentist determines that a surgical guide is necessary to ensure safe and accurate implant placement. The office fabricates a custom radiographic/surgical index, documents the rationale in the clinical notes, and submits a claim using D6190 with supporting images and a narrative. The insurance company requests additional information, which the office promptly provides, resulting in successful reimbursement for the index as a separate service.

This example highlights the importance of clear documentation, proactive communication with payers, and the correct use of D6190 to support optimal patient outcomes and practice revenue.