Understanding Dental Code D6790

When to Use D6790 dental code

The D6790 dental code is designated for a "retainer crown – indirect resin-based composite" in dental billing. This code is specifically used when a retainer crown is fabricated for a fixed partial denture (FPD), commonly known as a bridge, and the crown is made from an indirect resin-based composite material. It is important to use D6790 only when the clinical situation meets these criteria: the crown serves as an abutment (retainer) for a bridge, and the material is not porcelain, ceramic, or metal, but rather an indirect resin-based composite. Using this code correctly ensures accurate claims and prevents denials due to miscoding.

Documentation and Clinical Scenarios

Proper documentation is essential when billing for D6790. The patient's chart should clearly indicate:

• The tooth or teeth serving as abutments for the FPD.
• The clinical rationale for selecting an indirect resin-based composite material (e.g., esthetic needs, metal allergies, or specific patient requests).
• Pre-operative and post-operative radiographs showing the abutment teeth and the final restoration.
• A detailed narrative describing the procedure, including the steps taken to fabricate and place the retainer crown.

Common clinical scenarios for D6790 include patients requiring a bridge in the anterior region where esthetics are a priority, or cases where metal-free restorations are indicated. Always ensure that the documentation supports the necessity and appropriateness of the material and the retainer function.

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D6790, follow these best practices:

• Verify coverage: Before treatment, confirm with the patient’s insurance whether indirect resin-based composite retainer crowns are a covered benefit. Some plans may restrict coverage to metal or porcelain materials.
• Submit supporting documentation: Always include clinical notes, radiographs, and a narrative with your claim. This helps justify the use of D6790 and expedites claim processing.
• Use correct CDT codes for related procedures: If other components of the bridge are being billed (such as pontics or other retainer crowns), use the appropriate CDT codes and ensure all codes are consistent with the treatment provided. For example, if a porcelain retainer crown is used elsewhere in the bridge, reference D6750 for a porcelain fused to high noble metal retainer crown.
• Monitor EOBs and AR: Review Explanation of Benefits (EOBs) carefully for any denials or requests for additional information. Address Accounts Receivable (AR) promptly by following up on outstanding claims and submitting appeals when necessary.
• Appeal denied claims: If a claim is denied, review the reason code, gather any missing documentation, and submit a detailed appeal letter. Highlight the clinical necessity and material choice in your appeal narrative.

Example Case for D6790

Case Study: A 42-year-old patient presents with a missing upper lateral incisor. The treatment plan includes a three-unit fixed bridge, with the right central incisor and canine serving as abutments. Due to the patient’s preference for a metal-free, highly esthetic solution, the dentist recommends indirect resin-based composite retainer crowns. The clinical notes detail the patient’s esthetic concerns and document the material choice. Pre- and post-op radiographs are taken, and a comprehensive narrative is included with the claim. The office verifies insurance coverage for D6790, submits all required documentation, and receives timely reimbursement without the need for appeal.

This example highlights the importance of proper code selection, thorough documentation, and proactive insurance communication when billing for D6790.