When is D6086 used?
The D6086 dental code applies to a single implant-supported porcelain or ceramic crown. This CDT code is utilized when a patient receives a crown that connects directly to a dental implant instead of a natural tooth. It's essential to differentiate D6086 from other implant and crown codes, including D6065 (implant-supported porcelain fused to metal crown) or D6057 (custom abutment), for proper billing and claims processing. Apply D6086 exclusively when the restoration consists of a single, all-ceramic or porcelain crown supported by an implant abutment.
D6086 Charting and Clinical Use
Accurate documentation is essential for successful reimbursement of D6086. Clinical records must clearly document:
The location and presence of the dental implant
Confirmation that the restoration is a single crown, not a bridge or multiple-unit prosthesis
The material composition (porcelain/ceramic exclusively)
Connection to an implant abutment (not a natural tooth)
Typical clinical applications involve replacing a single missing tooth with an implant and restoring it using a porcelain crown. Include pre-treatment and post-treatment radiographs, intraoral photographs, and a detailed narrative explaining why the implant-supported crown was necessary. This comprehensive documentation supports claim approval and minimizes denial risks.
Billing and Insurance Considerations
Processing claims for D6086 demands careful attention to detail. Here are practical steps for improving claim success rates:
Confirm insurance benefits prior to treatment, since many policies have specific limitations or waiting periods for implants and associated restorations.
Provide complete documentation with claims, including clinical records, radiographs, and a comprehensive narrative.
Apply the appropriate CDT code for each part of the implant restoration. For instance, if a custom abutment is used, bill it separately with D6057.
Examine the Explanation of Benefits (EOB) thoroughly. When claims are denied, look for incomplete documentation or coding mistakes, and prepare to file an appeal with additional supporting materials.
Monitor accounts receivable (AR) to ensure prompt follow-up on pending claims and reduce payment delays.
How dental practices use D6086
A 52-year-old patient comes in with a missing upper right first molar. Following a complete assessment, the dentist installs a dental implant. After three months, the site is prepared for restoration. The dentist creates and places a porcelain crown that connects to the implant abutment. The clinical documentation specifies the porcelain/ceramic crown material, and radiographs verify correct positioning. The practice submits D6086 for the crown and D6057 for the custom abutment. Complete documentation accompanies the claim, and the insurance company approves payment following review of the detailed narrative and supporting images.
This case demonstrates the significance of proper code selection, complete documentation, and effective insurance communication for successful D6086 reimbursement.
Common Questions
What causes D6086 claim denials most frequently?
D6086 claim denials typically occur due to inadequate documentation including missing radiographs or clinical notes, mix-ups with similar procedure codes such as D6058, insufficient proof that the crown is implant-supported, and failure to verify patient coverage or frequency restrictions before submission. Comprehensive documentation and precise coding are essential for avoiding these rejections.
Does D6086 apply to crowns constructed from non-porcelain materials?
D6086 is exclusively designated for single implant-supported crowns fabricated from porcelain or ceramic materials. When the crown consists of alternative materials like metal or resin, practitioners must select the appropriate CDT code that corresponds to the actual crown material used.
Do insurance plans mandate preauthorization for D6086 treatments?
Preauthorization policies for D6086 procedures differ among insurance companies. While some insurers mandate prior approval for implant-supported crowns, others do not impose this requirement. Dental practices should contact the patient's insurance company prior to treatment to confirm preauthorization requirements and maintain records of all coverage-related correspondence.