Understanding Dental Code D6980
When to Use D6980 dental code
The D6980 dental code is designated for the repair of a fixed partial denture (commonly known as a bridge) when the repair is required due to the failure of restorative material, such as porcelain or metal. This code should be used only when the repair is necessitated by the breakdown or fracture of the restorative material itself, not for repairs due to trauma, caries, or issues unrelated to the original restorative material. Proper use of D6980 ensures accurate reporting and reimbursement for the specific service rendered.
Documentation and Clinical Scenarios
Accurate documentation is crucial when billing with D6980. The clinical notes should clearly describe the type of material failure (e.g., fractured porcelain facing, debonded metal framework), the location and extent of the damage, and the specific repair performed. Photographs, intraoral images, and radiographs can strengthen the claim and support medical necessity. Common clinical scenarios include:
- Porcelain chipping or fracture on a fixed bridge pontic or retainer
- Loss of metal framework integrity requiring soldering or welding
- Delamination or debonding of veneering material from the substructure
Always include the original date of placement of the prosthesis in the patient’s chart and on the claim form, as many payers require this information to determine coverage eligibility.
Insurance Billing Tips
To maximize reimbursement for D6980, follow these best practices:
- Verify benefits: Confirm with the payer that repairs to fixed partial dentures are a covered benefit and check for frequency limitations or waiting periods.
- Submit detailed narratives: Include a concise narrative explaining why the repair was necessary, referencing the restorative material failure and not patient misuse or unrelated causes.
- Attach supporting documentation: Upload clinical photos, radiographs, and chart notes with your claim submission.
- Use correct CDT codes: If the repair involves other procedures ensure each service is billed with the appropriate code and documentation.
- Monitor EOBs: Review Explanation of Benefits statements for denials or requests for additional information. If denied, prepare a claim appeal with supplemental documentation.
Example Case for D6980
Case: A patient presents with a three-unit porcelain-fused-to-metal bridge placed five years ago. The porcelain facing on the pontic has fractured, but the underlying metal framework and abutments are intact. The dentist repairs the porcelain in-office, restoring form and function.
Billing Steps:
- Document the fracture, including intraoral photos and a narrative describing the restorative material failure.
- Verify insurance coverage for fixed partial denture repairs and note any frequency limitations.
- Submit the claim using D6980, attaching all supporting documentation and the original placement date.
- Monitor the EOB for payment or additional information requests, and respond promptly if an appeal is needed.
By following these steps, dental teams can ensure proper reimbursement and compliance when using the D6980 dental code.
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