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When is D6117 used?
The D6117 dental code is utilized for reporting an implant/abutment supported fixed denture in a partially edentulous mandibular arch. This code is appropriate when a patient has lost some teeth in the lower jaw but retains others, and the treatment involves a fixed prosthetic device secured by implants and abutments. D6117 differs from codes designated for completely edentulous arches or removable appliances. It's important to confirm the patient's clinical condition and treatment approach to ensure D6117 is the correct code choice, as accurate coding is vital for successful claim processing and payment.
D6117 Charting and Clinical Use
Proper documentation is critical when submitting claims for D6117. Your clinical records must clearly document:
The patient has partial tooth loss in the mandibular arch.
Implants and abutments support a fixed denture restoration.
Information about the quantity and positioning of placed implants.
Pre-treatment and post-treatment radiographs and photographs when available.
The clinical reasoning for selecting a fixed restoration over a removable option.
Typical clinical situations involve patients who have experienced loss of multiple lower teeth from injury, gum disease, or dental caries, and who want a stable, permanent prosthetic solution. When the patient has no remaining teeth in the mandibular arch, refer to the appropriate code for complete edentulism.
Billing and Insurance Considerations
To optimize reimbursement and reduce claim rejections for D6117, implement these strategies:
Coverage Verification: Prior to treatment, confirm the patient's insurance plan includes benefits for implant-supported fixed dentures and review any limitations or waiting periods.
Prior Authorization: Request pre-approval with comprehensive documentation (X-rays, treatment narrative, periodontal records) to establish medical necessity.
Claim Processing: Submit claims using the correct CDT code (D6117) with all required supporting materials. Provide clear descriptions of the clinical situation and justification for fixed prosthetic treatment.
Benefits Review: Examine the explanation of benefits for correctness after claim adjudication. Address any denials by checking for incomplete documentation or coding mistakes.
Appeal Procedures: When required, file comprehensive appeals with additional supporting evidence, highlighting the patient's partial tooth loss and clinical necessity for fixed treatment.
How dental practices use D6117
Practice Example: A 58-year-old patient arrives with five absent mandibular teeth resulting from gum disease. Following assessment, the treatment team installs three implants and constructs a fixed denture with custom abutment support. Records include initial radiographs, clinical photographs, and detailed notes explaining the patient's choice for fixed treatment due to challenges with removable appliances. The practice submits the claim using D6117 with complete documentation and pre-treatment authorization. The insurance company approves coverage, resulting in timely payment to the practice.
This case demonstrates how proper record-keeping, comprehensive insurance verification, and effective communication with insurance providers ensure successful D6117 claim processing.
Common Questions
How do dental codes D6117 and D6118 differ from each other?
D6117 applies to implant/abutment supported fixed dentures for partially edentulous mandibular arches (lower jaw), whereas D6118 is specifically for partially edentulous maxillary arches (upper jaw). Both codes cover fixed prostheses that are supported by implants and abutments, with the specific jaw arch being treated determining the correct code selection.
What are typical reasons insurance claims get denied for D6117?
Frequent denial reasons include inadequate documentation such as missing radiographs or clinical notes, incorrect application of the code to fully edentulous rather than partially edentulous arches, absence of required pre-authorization, or exceeding insurance frequency limits for implant-supported prosthetics. Thorough documentation and prior coverage verification can help minimize claim rejections.
Is D6117 applicable for immediate loading implant procedures?
D6117 is appropriate for immediate loading implant procedures provided the clinical scenario aligns with the code definition: a fixed prosthesis supported by implants and abutments in a partially edentulous mandibular arch. Documentation must clearly specify the immediate loading protocol and provide clinical rationale supporting this treatment approach.