When is D6790 used?
The D6790 dental code applies to "retainer crown – indirect resin-based composite" procedures in dental practice billing. This specific code should be utilized when creating a retainer crown for a fixed partial denture (bridge) using indirect resin-based composite materials. D6790 is appropriate only when specific conditions are met: the crown functions as a bridge abutment (retainer), and the restoration material consists of indirect resin-based composite rather than porcelain, ceramic, or metal alternatives. Accurate application of this code helps ensure proper claim processing and reduces the risk of billing rejections due to incorrect coding practices.
D6790 Charting and Clinical Use
Accurate record-keeping is crucial when submitting claims for D6790. Patient documentation must clearly show:
Identification of the tooth or teeth functioning as bridge abutments.
Clinical justification for choosing indirect resin-based composite material (such as aesthetic requirements, metal sensitivities, or patient preferences).
Before and after radiographic images displaying the abutment teeth and completed restoration.
Comprehensive procedure notes outlining the fabrication and placement process for the retainer crown.
Typical clinical applications for D6790 involve patients needing anterior bridges where appearance is crucial, or situations requiring metal-free dental work. Documentation must always validate both the material selection and the retainer crown's functional necessity.
Billing and Insurance Considerations
To optimize payment outcomes and reduce claim rejections when submitting D6790, implement these strategies:
Check benefit coverage: Prior to treatment, verify whether the patient's insurance plan covers indirect resin-based composite retainer crowns. Certain policies may limit coverage to metal or porcelain options only.
Include comprehensive documentation: Submit clinical records, radiographic images, and detailed procedure narratives with every claim. This documentation validates the D6790 code usage and speeds up claim review processes.
Apply appropriate CDT codes for additional procedures: When billing for other bridge components (like pontics or additional retainer crowns), select the correct corresponding CDT codes that align with the actual treatment delivered. For instance, when using a porcelain retainer crown elsewhere in the same bridge, consider D6750 for porcelain fused to high noble metal retainer crowns.
Track EOBs and outstanding accounts: Carefully examine Explanation of Benefits statements for any rejections or information requests. Handle outstanding accounts receivable promptly by following up on pending claims and filing appeals when appropriate.
Contest rejected claims: When claims are denied, examine the denial reason, collect any missing documentation, and file a comprehensive appeal. Emphasize the clinical necessity and material rationale in your appeal documentation.
How dental practices use D6790
Practice Example: A 42-year-old patient comes in with a missing upper lateral incisor. The recommended treatment involves a three-unit bridge using the right central incisor and canine as supporting teeth. Based on the patient's desire for a metal-free, highly aesthetic result, the dentist selects indirect resin-based composite retainer crowns. Clinical documentation records the patient's aesthetic requirements and material selection rationale. Complete radiographic series are captured before and after treatment, with detailed procedure notes accompanying the insurance submission. The practice confirms D6790 coverage with the insurance carrier, provides all necessary documentation, and receives prompt payment without requiring additional appeals.
This case demonstrates the significance of appropriate code application, complete documentation practices, and proactive insurance verification when processing D6790 claims.
Common Questions
Do all dental insurance plans provide coverage for D6790?
Insurance coverage for D6790 differs significantly between plans. Many dental insurance policies do not include benefits for fixed partial dentures or retainer crowns. Always confirm your patient's specific coverage details and any applicable limitations prior to beginning treatment.
Is D6790 the correct code for crowns supported by implants?
D6790 should not be used for implant-supported crowns. This code applies exclusively to retainer crowns that form part of a fixed partial denture (bridge) and does not cover crowns placed on dental implants. Implant-supported crowns require different CDT codes designed specifically for that purpose.
What typically causes claim rejections when submitting D6790?
Frequent causes of claim rejections include inadequate documentation (missing radiographs or clinical notes), incorrect code usage for single-unit crowns rather than bridge retainers, or absence of bridge coverage in the patient's insurance plan. Comprehensive documentation and proper code application can help avoid these rejections.