When is D5923 used?
The D5923 dental code applies to an interim ocular prosthesis. This CDT code is utilized when patients need a temporary artificial eye, commonly after eye removal surgery or serious eye injury. The temporary prosthesis acts as a placeholder during tissue recovery or while waiting for a permanent ocular prosthesis to be created. Dental practices should apply D5923 exclusively for temporary solutions, not for final or permanent prostheses, which require different billing codes. Correct code usage ensures proper claims processing and meets insurance compliance standards.
D5923 Charting and Clinical Use
Proper documentation is crucial when submitting claims for D5923. Clinical records must clearly indicate why an interim prosthesis is needed, including recent surgery, injury, or infection. Document the date of eye removal or trauma, describe the patient's recovery progress, and explain why a temporary device is necessary. Supporting materials like photographs, surgical reports, and ophthalmologist referrals can enhance claim approval. Typical clinical situations include:
Immediate placement following surgical eye removal
Temporary restoration after trauma with extensive tissue damage
Cases requiring tissue healing before permanent prosthesis fabrication
Maintain updated patient records with progress documentation and scheduling plans for the permanent prosthesis.
Billing and Insurance Considerations
Processing D5923 claims requires careful attention to prevent rejections and processing delays. Follow these guidelines for successful reimbursement:
Check coverage details: Verify whether the patient's dental and medical plans cover interim ocular prostheses, as some insurers may classify this as a medical procedure.
Obtain prior approval: Secure pre-authorization or predetermination when available, including clinical records and justification for the temporary device.
Include supporting materials: Provide surgical notes, photographs, and referral documentation with claims. This establishes medical necessity and speeds up approval processes.
Apply proper coding: Avoid mixing D5923 with permanent prosthesis codes, such as D5922 (permanent ocular prosthesis).
Monitor claim responses: Review benefit explanations quickly to handle denials or information requests. For rejected claims, submit appeals promptly with additional supporting documentation as required.
How dental practices use D5923
A patient requires eye removal surgery due to ocular cancer. The maxillofacial prosthodontist provides an interim ocular prosthesis right after surgery to preserve facial appearance and aid in healing. The billing staff confirms insurance benefits, secures prior approval, and files the claim with surgical documentation and the ophthalmologist's referral. After claim approval, the patient schedules a follow-up appointment in three months for assessment and creation of the permanent prosthesis, which will be processed under D5922. This process guarantees appropriate payment and seamless patient care.
Common Questions
What is the typical duration for wearing an interim ocular prosthesis under code D5923?
The wearing period for an interim ocular prosthesis depends on individual healing patterns and how well the eye socket tissues stabilize. Most patients use interim prostheses for several weeks up to a few months while the surgical site heals adequately for a permanent prosthesis. The specific timeline should always be established through collaboration between the clinical team and the referring ophthalmologist based on the patient's progress.
What specific care guidelines should patients follow when using an interim ocular prosthesis?
Patients must receive comprehensive care instructions covering proper cleaning techniques, safe handling procedures, warning signs of infection or other complications, and scheduled follow-up appointment requirements. Maintaining excellent hygiene practices and adhering to regular monitoring schedules are crucial for promoting proper healing and avoiding potential complications during the interim prosthesis period.
Is it possible to bill D5923 together with other dental or medical services during the same appointment?
D5923 may be billed concurrently with other procedures when they are medically warranted and clearly distinguishable services. Insurance providers often maintain specific bundling guidelines and restrictions, making it essential to thoroughly review coverage policies and apply correct modifiers when necessary. Comprehensive documentation supporting the medical necessity of each billed service is always required.