When is D5985 used?
The D5985 dental code applies to creating a radiation cone locator, which is a specialized tool used in dental X-ray procedures to ensure proper positioning and protection. This CDT code should be applied when a customized locator is needed to enhance patient safety and improve image quality, particularly in complicated restorative or prosthodontic situations where regular radiographic guides don't work well. Dental practices should apply D5985 when creating a radiation cone locator specifically designed for an individual patient, not when using standard or reusable equipment.
D5985 Charting and Clinical Use
Proper documentation is crucial when billing D5985. Patient records must clearly show the medical need for a customized radiation cone locator, explaining the patient's particular anatomical or restorative requirements. Documentation should include:
The specific radiographic procedure being conducted
Reasons why a standard locator won't work
How the customized locator enhances diagnostic precision or patient protection
Typical situations involve patients with complex prosthodontic treatments, implants, or anatomical differences that make standard radiographic positioning difficult. Always include supporting clinical photographs and comprehensive notes in both the patient record and insurance submission to support the use of D5985.
Billing and Insurance Considerations
When filing claims for D5985, use these strategies to increase approval chances and reduce claim rejections:
Prior approval: Check with the patient's dental coverage to confirm if D5985 is included before starting the procedure. Some insurance plans may not cover it or have restrictions.
Complete explanations: Provide a comprehensive description of why the radiation cone locator was required, citing clinical observations and treatment objectives.
Accurate coding: Confirm that D5985 is the right code for the service delivered. If a different code, like D6190 (radiographic/surgical implant index), fits better, use that one.
Supporting materials: Include relevant documentation like X-rays, clinical images, and patient notes with your claim to speed up review.
Claim appeals: When claims get denied, check the benefits explanation for the denial reason, improve documentation as necessary, and file a prompt appeal with extra supporting materials.
How dental practices use D5985
Take a patient who has several dental implants in the upper back teeth, where regular X-ray positioning devices don't give clear images because of angle and anatomy issues. The dentist creates a specialized radiation cone locator to ensure accurate positioning for detailed X-rays. The patient notes describe the implant setup, explain why standard guides don't work, and show how the custom locator improves diagnosis. The insurance claim uses D5985 and includes a detailed explanation, pictures, and supporting records. The insurance company reviews the complete submission and approves payment, leading to prompt reimbursement and better patient treatment.
Common Questions
Can general dentists perform D5985, or is it restricted to dental specialists?
D5985 is primarily utilized by prosthodontists and oral surgeons given the complex nature of cases requiring radiation cone locators. However, general dentists who possess adequate training and encounter appropriate clinical situations can also fabricate and provide this device. The essential requirement is maintaining proper documentation that demonstrates medical necessity and the clinical circumstances that warrant its application.
What are typical reasons for insurance claim denials when billing D5985?
Insurance providers may reject D5985 claims when documentation fails to clearly demonstrate medical necessity, when the device is considered experimental or falls outside the patient's coverage, or when supporting evidence like radiographs, photographs, or detailed narratives is insufficient. Additional denial reasons include inappropriate billing with unrelated procedure codes or failure to obtain required preauthorization.
What approach should dental offices take when discussing potential D5985 costs with patients?
Dental offices should proactively communicate with patients about possible out-of-pocket expenses when D5985 may not receive insurance coverage. This conversation should cover the clinical rationale for the device, efforts being made to obtain insurance approval, and cost estimates. Clear, upfront communication helps set appropriate patient expectations and ensures proper informed consent prior to treatment initiation.