When is D5671 used?
The D5671 dental code applies to replacing all teeth and acrylic components on a cast metal framework for mandibular (lower jaw) removable partial dentures. This procedure code is utilized when existing partial denture teeth and acrylic materials have become worn, broken, or degraded, while the underlying metal framework remains in good condition. This code should not be applied for initial denture construction or situations where the metal framework also needs replacement; such cases require codes for new partial dentures. Correct application of D5671 helps ensure proper documentation and payment for comprehensive repairs that restore both function and appearance without the expense of creating an entirely new prosthetic device.
D5671 Charting and Clinical Use
Proper documentation plays a crucial role in claim acceptance when submitting D5671. Clinical records must clearly describe the current prosthesis condition, including:
Evaluation of the cast metal framework's structural soundness
Documentation of tooth and acrylic deterioration, breaks, or missing components
Justification for complete tooth and acrylic replacement versus limited repairs
Before and after photographs when available
Original prosthesis placement date and history of previous repairs
Typical clinical situations involve patients with older partial dentures showing widespread tooth deterioration, acrylic color changes, or multiple tooth breaks, while the metal framework continues to fit properly and remains structurally intact.
Billing and Insurance Considerations
To optimize payment and reduce claim rejections for D5671, implement these recommended practices:
Coverage Verification: Check patient benefits for major prosthetic repair coverage and timing restrictions before beginning treatment. Certain plans may restrict repairs within specific periods following initial placement.
Prior Authorization: File prior authorization requests with comprehensive clinical records and photographs to demonstrate treatment necessity, minimizing post-treatment claim denials.
Claim Processing: Specify D5671 clearly on claim forms, include supporting documentation, and provide written explanations for why complete replacement was unnecessary.
Benefits Review: Examine explanation of benefits carefully for denial explanations. For denied claims, prepare appeals with additional documentation emphasizing the procedure's cost-effectiveness and clinical appropriateness.
Monitor payer policy updates, as some insurers may require extra documentation or maintain specific criteria for prosthetic repairs compared to replacements.
How dental practices use D5671
Practice Example: A 68-year-old patient arrives with a mandibular partial denture installed seven years earlier. The metal framework remains undamaged and fits appropriately, but all acrylic teeth show wear and several are broken. Clinical examination and X-rays verify the framework's continued serviceability. The dental practice records these findings, captures pre-treatment images, and files prior authorization with detailed notes explaining the necessity for complete tooth and acrylic renewal. Insurance approves the D5671 claim, allowing the patient to receive a fully restored partial denture at reduced cost compared to new prosthesis fabrication.
For similar procedures involving limited tooth or acrylic repairs, consider alternative codes such as D5670 for upper jaw partials or D5611 for resin base repairs, making sure to choose the most suitable code for each clinical situation.
Common Questions
What is the billing frequency for D5671 procedures?
The billing frequency for D5671 varies based on individual insurance coverage. Most dental insurance plans impose frequency restrictions on prosthetic replacements, typically permitting coverage once every 5-7 years unless there is documented clinical necessity for earlier replacement. It's essential to review the patient's specific benefit structure and secure pre-authorization whenever feasible.
Does medical insurance provide coverage for D5671, or is it limited to dental plans?
D5671 falls under CDT (Current Dental Terminology) coding and is typically covered exclusively by dental insurance policies. Medical insurance plans generally exclude dental prosthetic treatments unless they are directly related to a medical condition or traumatic injury. It's important to confirm coverage details with the patient's dental insurance carrier.
What information should be provided in the laboratory prescription for D5671 procedures?
The laboratory prescription for D5671 must clearly indicate the replacement of all teeth and acrylic components on the existing cast metal framework. Essential details include shade specifications, tooth mold selection, acrylic material type, and any particular requirements for fit or aesthetic outcomes. Including clinical photographs and a copy of the treatment plan will assist the laboratory in achieving superior results.