When is D6190 used?
The D6190 dental code applies to creating and utilizing a radiographic or surgical implant index, billed as a separate service from the implant procedure itself. This code is appropriate when dental professionals develop a specialized guide or template to ensure accurate dental implant positioning. The template serves radiographic assessment, surgical guidance, or both functions, proving vital in situations demanding high precision—including complicated implant procedures, multiple implant installations, or cases requiring careful navigation around anatomical features.
D6190 Charting and Clinical Use
Accurate record-keeping is crucial for obtaining reimbursement for D6190. Patient records must clearly outline why the index is necessary, how it was created, and its purpose (radiographic, surgical, or combined use). Include diagnostic imaging (like CBCT scans or panoramic radiographs) and comprehensive narratives explaining why the index is required. Typical situations include:
Patients with insufficient bone density or close proximity to critical anatomical features.
Multiple implant cases requiring exact positioning and proper spacing.
Circumstances where a surgical template is essential for minimally invasive implant procedures.
Ensure that clinical documentation aligns with claim submissions and includes comprehensive supporting materials to prevent processing delays or claim rejections.
Billing and Insurance Considerations
Successfully billing D6190 demands careful attention to specifics. Follow these guidelines to improve claim approval rates:
Prior approval: Request pre-authorization with supporting materials, including imaging and comprehensive explanations, to confirm coverage before treatment begins.
Detailed billing: Keep the D6190 fee distinct from other implant services (such as implant installation or abutment services), since combining procedures may lead to claim denials.
Challenge rejections: When claims are denied, examine the benefits explanation for specific reasons, then file an appeal with extra documentation or clarification when necessary.
Confirm benefits: Since not every dental insurance plan includes D6190 coverage, always check benefits and restrictions with the insurance provider before starting treatment.
Proper CDT coding and complete documentation remain fundamental for successful payment and regulatory compliance.
How dental practices use D6190
Practice Example: A patient requires replacement of two absent lower molars. Given the close location of the mandibular nerve and reduced bone dimension, the practitioner decides a surgical template is essential for safe and precise implant positioning. The practice creates a customized radiographic/surgical guide, records the clinical reasoning in patient files, and files a claim using D6190 with supporting radiographs and detailed explanation. When the insurance provider requests more information, the office quickly responds, leading to approved payment for the guide as an independent procedure.
This scenario demonstrates the value of thorough documentation, proactive insurance communication, and proper D6190 application to achieve excellent patient care and practice profitability.
Common Questions
Does medical insurance or dental insurance cover D6190?
D6190 is generally processed through dental insurance since it involves dental implant procedures. In uncommon situations where the index is medically necessary due to trauma or a medical condition, certain medical insurance providers might provide coverage. It's important to verify coverage policies directly with your specific insurance provider for dental implant-related procedure codes.
Is it possible to bill D6190 multiple times for one patient?
Yes, D6190 may be billed multiple times when separate indices are medically warranted for different treatment phases or various implant locations. Each billing instance requires thorough documentation with clear justification explaining why an additional index was necessary. Claims submitted without adequate documentation may face rejection.
What typically causes D6190 claims to be denied?
Frequent denial causes include inadequate documentation, missing detailed narratives that explain medical necessity, absent supporting imagery, or the procedure being viewed as included in another billed service. Some insurance policies may also have specific exclusions for implant-related treatments, making prior coverage verification crucial.