Understanding Dental Code D8695

When to Use D8695 dental code

The D8695 dental code is designated for the removal of fixed orthodontic appliances for reasons other than the completion of orthodontic treatment. This CDT code is crucial when a patient needs their braces or other fixed appliances taken off prematurely due to circumstances such as medical complications, patient relocation, financial hardship, or non-compliance with treatment. It is important to note that D8695 should not be used when the removal is part of the planned, successful completion of orthodontic therapy; in those cases, a different code applies, such as D8680 for orthodontic retention.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing D8695. The clinical notes must clearly state the reason for premature appliance removal, including any relevant patient history, communications, and supporting evidence (e.g., medical recommendations, patient requests, or financial records). Common scenarios include:

• Medical necessity: The patient develops a condition (e.g., severe oral infection, allergy to appliance materials) requiring immediate removal.
• Patient relocation: The patient is moving and cannot continue treatment at your office.
• Non-compliance: The patient is not following treatment protocols, making continued orthodontic care unfeasible.
• Financial hardship: The patient can no longer afford ongoing orthodontic care.

Always include detailed progress notes, patient consent forms, and any correspondence that supports the necessity for removal. This thorough documentation will be invaluable if the claim is questioned or denied by insurance.

Insurance Billing Tips

When submitting a claim for D8695, best practices include:

• Pre-verification: Confirm with the patient’s insurance plan whether D8695 is a covered benefit and if any pre-authorization is required.
• Detailed claim submission: Attach clinical notes, patient communications, and any supporting documentation to the claim. Clearly indicate the reason for premature removal in the narrative section.
• Monitor EOBs: Review Explanation of Benefits (EOBs) carefully for payment status or denial reasons. If denied, check for missing documentation or request a peer-to-peer review if appropriate.
• Appeal process: If the claim is denied, promptly submit an appeal with additional documentation and a detailed explanation of medical necessity or other qualifying circumstances.

Staying proactive and organized in your billing workflow will reduce AR (accounts receivable) days and improve claim acceptance rates.

Example Case for D8695

Case: A 15-year-old patient with fixed braces develops a persistent oral allergy to the appliance materials. After consulting with the patient’s physician and orthodontist, the decision is made to remove the appliances before treatment completion. The dental office documents the allergy diagnosis, includes correspondence from the physician, and obtains written consent from the patient’s guardian. The claim for D8695 is submitted with all supporting documentation, and the insurance carrier approves the claim after reviewing the medical necessity.

This example highlights the importance of comprehensive documentation and clear communication with both the patient and the insurance provider when using the D8695 dental code.