When is D6751 used?
The D6751 dental code applies to billing for a retainer crown made of porcelain fused to predominantly base metal. This CDT (Current Dental Terminology) code is specifically utilized when a retainer crown is required as part of a fixed partial denture (FPD), also called a bridge. Apply D6751 when the clinical case requires a retainer crown to anchor a bridge, using porcelain fused to base metal materials like nickel-chromium or cobalt-chromium alloys. This code is not suitable for individual crowns or retainers constructed from different materials (such as all-ceramic or high noble metals—refer to D6750 or D6752 for those situations).
D6751 Charting and Clinical Use
Proper documentation is essential for successful reimbursement of D6751. Your clinical records should clearly document:
The specific tooth number(s) and their current condition
The clinical diagnosis supporting the need for a fixed partial denture (e.g., adjacent missing tooth)
The material choice (porcelain fused to base metal) and clinical reasoning
Before and after radiographs or clinical photographs
Comprehensive charting of abutment teeth and the space without teeth
Typical clinical situations involve restoring a missing tooth using a bridge where the supporting tooth needs a retainer crown for proper stability. Always confirm your documentation justifies the clinical necessity and material selection for the retainer crown.
Billing and Insurance Considerations
To improve claim approval rates for D6751, implement these strategies:
Confirm patient benefits and coverage for fixed partial dentures and specific crown materials prior to starting treatment.
Request pre-authorization with supporting materials, including diagnostic images and a comprehensive narrative explaining the retainer crown necessity and material choice.
Apply accurate CDT codes for all bridge components (retainer crown, pontic, etc.), maintaining consistency between clinical documentation and billing forms.
Examine EOBs (Explanation of Benefits) thoroughly for denial explanations. When claims are rejected, prepare a claim appeal with supplementary documentation or clarification when required.
Monitor claims in your accounts receivable (AR) system to maintain timely follow-up and resolution.
Keep in mind that insurance companies may impose frequency limits or material restrictions, so always verify the plan details before treatment.
How dental practices use D6751
Take a patient missing tooth #19, with teeth #18 and #20 as supporting structures. Following clinical assessment, you decide that tooth #18 needs a retainer crown constructed from porcelain fused to base metal to support a three-unit bridge. You record the area without teeth, the gum and restorative condition of supporting teeth, and the material choice. A pre-authorization is requested with X-rays and a detailed explanation. The claim is submitted using D6751 for the retainer crown on #18, along with appropriate codes for the pontic and additional retainer. After evaluation, the insurance company approves the claim, and payment is recorded in AR. This process shows the significance of proper coding, complete documentation, and proactive insurance coordination.
Common Questions
Is D6751 applicable for pediatric patients or restricted to adult use only?
D6751 is appropriate for both pediatric and adult patients when the clinical circumstances justify the placement of a fixed partial denture (bridge) featuring a porcelain fused to predominantly base metal retainer crown. Age does not serve as a restriction for this code; instead, the determining factors are the patient's dental requirements and whether a bridge is suitable for their specific treatment plan.
What are typical reasons insurance companies deny D6751 claims?
Insurance denials for D6751 claims frequently occur due to inadequate documentation (including absent radiographs or clinical records), failure to obtain required pre-authorization, material coverage restrictions, or determinations that the procedure lacks medical necessity. Comprehensive documentation and benefit verification prior to treatment can help minimize these denial risks.
What distinguishes D6751 from codes used for individual crowns or alternative retainer crown types?
D6751 applies exclusively to retainer crowns constructed from porcelain fused to predominantly base metal materials within a fixed partial denture (bridge) framework. This code does not apply to individual crowns or retainers fabricated from alternative materials like all-ceramic or high noble metal compositions. These alternative scenarios require different CDT codes, making precise material and procedure identification crucial for appropriate coding practices.