When is D5867 used?
The D5867 dental code applies to replacing a replaceable component of a semi-precision or precision attachment, particularly the male or female part. This CDT code comes into play when a patient's removable appliance, like a partial denture, needs a new attachment component because of wear, breakage, or reduced retention. Keep in mind that D5867 is not appropriate for initial attachment placement or for repairs that don't involve the replaceable part. Using this code correctly helps ensure proper billing and prevents claim rejections or processing delays.
D5867 Charting and Clinical Use
Complete documentation is crucial for successful payment when submitting D5867. Dental offices should record:
Clinical records explaining why replacement is needed (such as worn, broken, or missing attachment part)
Before and after photographs when available, to show the necessity and results
Product information or part specifications of the replaced component
Patient's appliance background, including original placement date and previous maintenance
Typical clinical situations for D5867 involve patients experiencing looseness in their partial denture, noticeable attachment wear, or decreased retention. For each situation, a detailed explanation of why the replacement is clinically necessary will strengthen the claim.
Billing and Insurance Considerations
To improve payment success and reduce rejections for D5867:
Check patient coverage prior to treatment, confirming benefits for appliance maintenance and replacement components.
Include supporting materials with the claim, such as clinical records, images, and product details.
Write detailed explanations to justify the replacement need and why a new attachment is necessary.
When denied, examine the Explanation of Benefits (EOB) and file an appeal with extra documentation if appropriate. Reference the patient's appliance timeline and clarify that D5867 covers replacement, not initial installation.
Note that certain plans may restrict frequency or require waiting periods for replacement components. Verify policy terms during benefit verification.
For related treatments, like appliance repairs, use the correct CDT code in your records and consider referencing resources such as repairs to partial dentures for additional guidance.
How dental practices use D5867
Practice Example: A 67-year-old patient visits with a lower partial denture that feels loose. Clinical examination shows the male part of the precision attachment is worn and fails to provide proper retention. The dental staff documents the problem with oral photographs and notes, confirms insurance benefits for replacement components, and files a claim using D5867. The submission includes an explanation: "Replacement of deteriorated male component of semi-precision attachment due to inadequate retention and patient discomfort. Original appliance placed in 2021; no previous component replacements." The insurance company approves payment, and the patient's appliance returns to normal function.
This case demonstrates how proper documentation, benefit verification, and clear communication with insurers leads to successful D5867 billing.
Common Questions
Does dental insurance typically cover D5867, and what influences coverage decisions?
Insurance coverage for D5867 differs significantly between plans. While some dental insurance policies include coverage for replacing semi-precision or precision attachment components, others exclude this service entirely or apply strict frequency restrictions. Coverage determination may also hinge on whether the replacement falls within the original prosthesis warranty period. To avoid claim denials, always confirm coverage details and limitations with the patient's insurance carrier prior to treatment and claim submission.
Is it possible to bill D5867 together with other prosthetic repair or maintenance procedures?
D5867 may be billed concurrently with other prosthetic repair or maintenance codes when multiple distinct services are performed during a single visit. However, insurance companies frequently bundle related procedures or reject claims they view as duplicative services. Proper documentation of each individual service is essential, and providers should review specific payer policies regarding procedure bundling to ensure appropriate billing practices.
What records should be maintained in the patient file when submitting claims for D5867?
Beyond standard clinical documentation and intraoral photographs, maintain comprehensive records including manufacturer specifications, component lot numbers, and all insurance correspondence. Thorough record-keeping supports claim processing, facilitates appeal procedures for denied claims, and ensures adherence to insurance requirements during potential audits or reviews.