When is D5512 used?
The D5512 dental code applies to repairing a fractured complete denture base in the upper (maxillary) arch. This CDT code is appropriate when patients have a broken or damaged upper denture base requiring professional restoration rather than complete replacement. Typical situations include fractures, cracks, or splits caused by accidental damage, normal wear, or poor fitting. Applying D5512 provides precise billing and proper reimbursement for this specific treatment, separating it from codes for new dentures or repairs involving artificial teeth or metal components.
D5512 Charting and Clinical Use
Thorough documentation is crucial for successful claim approval. When submitting D5512, dental offices should maintain comprehensive clinical records detailing the damage type and extent, repair procedures performed, and materials utilized. Supporting evidence may include clinical photographs, relevant radiographs, and written explanations for choosing repair over replacement. Common clinical applications for D5512 include:
Upper denture base shows cracking while all artificial teeth stay undamaged.
Base fracture from accidental impact requiring professional laboratory restoration.
Age-related deterioration or splitting of the maxillary denture base without tooth damage.
Confirm that repairs exclude adding or replacing denture teeth, which would necessitate different CDT codes, such as D5520 for tooth-related repairs.
Billing and Insurance Considerations
To optimize payment and reduce claim rejections for D5512, implement these strategies:
Confirm coverage and eligibility: Validate that the patient's insurance includes denture repair benefits and review any frequency restrictions or waiting requirements.
Provide complete documentation: Include detailed clinical records, photographs, and clear explanations with claims. This demonstrates treatment necessity and explains the repair specifics.
Ensure proper CDT selection: Verify that D5512 matches the actual repair provided. Incorrect coding can cause payment delays or trigger claim reviews.
Monitor EOB statements: Review payment explanations for accuracy and address any payment issues or denials through appropriate appeal processes.
Manage receivables actively: Watch outstanding claims and contact insurance companies when necessary to ensure timely payment processing.
How dental practices use D5512
Practice Example: A 68-year-old patient arrives with a broken upper denture base following an accidental drop. While the artificial teeth remain undamaged, the base shows a complete fracture through the palatal area. The dentist evaluates the damage and decides repair is the best treatment option, sending the appliance for laboratory restoration. The practice team records the incident details, captures damage photographs, and creates documentation explaining the repair choice. They submit the claim using D5512 with all supporting materials. The insurance company processes the claim successfully, resulting in prompt payment.
This scenario demonstrates the value of accurate coding, complete record-keeping, and effective billing procedures when utilizing the D5512 dental code.
Common Questions
Is it possible to bill D5512 alongside other denture repair codes during a single appointment?
D5512 can indeed be billed with other denture repair codes like D5611 or D5621 when both denture base and tooth repairs are needed in the same visit. Each repair must be documented individually with clear clinical notes describing the specific work performed. Always verify the patient's insurance coverage for any bundling restrictions or limits on multiple repair procedures per appointment.
What is the typical completion time for a D5512 denture base repair?
Completion time for D5512 repairs varies based on damage severity and whether work is done in-office or at a dental lab. Minor repairs might be finished in a few hours, while complex cases or lab-required work could take several days. Always provide patients with realistic timeframes based on their specific repair needs.
What materials or methods are required for D5512 repairs to qualify for insurance coverage?
No specific materials or techniques are universally required for D5512 repairs, but the work must effectively restore denture base function and structural integrity. Dentists should select appropriate dental materials and repair methods based on the damage type. Thorough documentation of materials used and repair techniques is crucial for successful insurance claims and reimbursement.