When is D2794 used?
The D2794 dental code is utilized to document the placement of a high noble metal crown. This CDT code is appropriate when a tooth needs complete coverage restoration due to significant decay, structural damage, or following endodontic treatment, and the restoration must be constructed from high noble metal materials for superior durability and performance. It's crucial to confirm that the material meets ADA standards for high noble metal, which generally requires at least 60% noble metal content, including a minimum of 40% gold.
D2794 Charting and Clinical Use
Accurate record-keeping is vital for proper reimbursement when submitting D2794 claims. Clinical documentation should clearly record:
The clinical diagnosis that supports the necessity for full-coverage restoration (such as extensive decay, tooth fracture, or post-endodontic requirements).
The rationale for selecting high noble metal as the restoration material (including factors like occlusal stress, material sensitivities, or particular clinical needs).
Pre-treatment radiographic images and clinical photographs that demonstrate the crown's medical necessity.
Comprehensive chart notes documenting the tooth preparation, impression procedures, and final cementation steps.
Typical clinical situations include posterior teeth with substantial tissue loss, patients who grind their teeth, or instances where material compatibility is a primary concern.
Billing and Insurance Considerations
To improve claim approval rates and reduce processing delays, implement these recommended practices:
Coverage Verification: Validate the patient's crown benefits, treatment frequency limits, and material coverage restrictions prior to beginning treatment. Some insurance plans may reduce benefits to cover less costly materials, so review potential patient costs beforehand.
Claims Processing: File comprehensive claims using the D2794 code with complete supporting materials and clear clinical reasoning. Include pre-treatment radiographs, clinical photographs, and detailed explanations for choosing high noble metal crowns.
Benefits Review: Thoroughly examine Explanations of Benefits for benefit reductions or claim rejections. When claims are denied based on material selection, reference clinical documentation and submit appeals with supplementary evidence when appropriate.
Receivables Management: Monitor pending claims and maintain timely communication with insurance carriers. Develop a structured appeals process that includes resubmitting claims with improved narratives and additional supporting materials.
How dental practices use D2794
A 55-year-old patient arrives with a broken maxillary first molar that previously received endodontic treatment. The treatment team decides that a high noble metal crown is the best option because of the patient's strong bite force and documented allergies to certain metals. The practice records the diagnosis, obtains pre-treatment x-rays, and documents the material selection rationale in the patient record. The insurance claim is filed using D2794 with supporting photographs and clinical explanation. Although the insurance company initially reduces the benefit amount, a successful appeal with comprehensive documentation results in approval at the full high noble metal crown benefit level.
Following these procedures and maintaining detailed clinical records helps dental practices achieve accurate coding and maximize reimbursement for treatments billed under D2794.
Common Questions
What is the typical cost range for a D2794 titanium crown, and does it cost more than other crown materials?
The cost for a D2794 titanium crown typically exceeds that of other crown materials like porcelain-fused-to-metal or all-ceramic options due to titanium's material costs and specialized manufacturing requirements. While exact pricing varies by geographic location and dental practice, patients should anticipate titanium crowns being among the higher-priced restorative choices. It's recommended to verify specific pricing with your dental provider and review potential out-of-pocket expenses with your insurance carrier.
Are there specific laboratory requirements or extended processing times for creating a titanium crown under D2794?
Titanium crowns necessitate specialized dental laboratories with titanium fabrication capabilities. Since not every dental lab provides this service, it can impact both laboratory selection and processing duration for the restoration. Dental practices should verify capabilities and anticipated delivery schedules with their preferred laboratory, as processing times may exceed those for conventional crown materials.
Is D2794 applicable for both natural teeth and dental implants, or does it have usage restrictions?
D2794 applies to both natural teeth and implant abutment restorations when clinical circumstances indicate a titanium crown is appropriate. The code has no specific usage limitations, however documentation must clearly indicate whether the crown is placed on a natural tooth or implant abutment, as this distinction may influence insurance coverage and claim processing procedures.