When is D6980 used?
The D6980 dental code applies to repairing fixed partial dentures (bridges) when restoration materials like porcelain or metal fail. This code is appropriate only when repairs address material breakdown or fractures in the original restorative components, not damage from trauma, decay, or unrelated factors. Using D6980 correctly helps ensure proper documentation and appropriate reimbursement for the specific treatment provided.
D6980 Charting and Clinical Use
Thorough documentation is essential when submitting claims under D6980. Clinical records must clearly detail the material failure type (such as cracked porcelain veneer or loose metal framework), damage location and severity, and the repair method used. Supporting evidence like photographs, intraoral scans, and X-rays can validate the claim and demonstrate treatment necessity. Typical clinical situations include:
Chipped or broken porcelain on bridge pontics or abutments
Metal framework damage requiring repair welding or soldering
Separation or loosening of veneer material from underlying structure
Document the prosthesis installation date in patient records and claim forms, as insurers often need this information for coverage determination.
Billing and Insurance Considerations
To optimize reimbursement for D6980, implement these strategies:
Check coverage: Confirm that fixed partial denture repairs are covered benefits and review any frequency restrictions or waiting requirements.
Provide detailed explanations: Include clear narratives explaining repair necessity, focusing on material failure rather than patient actions or unrelated factors.
Include supporting materials: Submit clinical photographs, X-rays, and treatment notes with your claim.
Apply proper coding: When repairs involve additional procedures, bill each service with appropriate codes and documentation.
Review payment responses: Examine benefit statements for denials or information requests. Prepare appeals with additional documentation when claims are rejected.
How dental practices use D6980
Scenario: A patient arrives with a three-unit porcelain-fused-to-metal bridge installed five years earlier. The pontic's porcelain surface has cracked, while the metal base and supporting teeth remain undamaged. The dentist performs an in-office porcelain repair, restoring appearance and function.
Processing Steps:
Record the damage with intraoral photographs and written description of the material failure.
Confirm insurance benefits for bridge repairs and check for any usage restrictions.
File the claim with D6980, including all documentation and original installation date.
Review payment explanation for approval or requests for more information, and prepare appeals if necessary.
Following these procedures helps dental offices secure appropriate payment and maintain compliance when applying the D6980 dental code.
Common Questions
Is it possible to bill D6980 together with other dental procedures during the same appointment?
D6980 can often be billed with other procedures performed in the same visit, as long as each procedure has proper clinical justification and thorough documentation. Keep in mind that insurance carriers may have bundling policies or limitations, so it's essential to verify the patient's coverage details and maintain detailed records for each procedure to prevent claim rejections.
Do most dental insurance plans have frequency restrictions for D6980 procedures?
Most dental insurance carriers establish frequency limits for prosthetic repair procedures, including D6980 claims. These restrictions typically limit repairs to once every 3-5 years or similar timeframes. It's crucial to confirm the patient's specific plan limitations prior to treatment to ensure proper coverage and prevent unexpected patient expenses.
What information should be provided in the narrative section when filing a D6980 claim?
An effective D6980 narrative must clearly indicate that repair is necessary due to restorative material breakdown, identify the specific location and nature of the damage (such as 'porcelain fracture on pontic #13'), and verify that abutment teeth and supporting structures remain healthy. Use precise language rather than general descriptions and ensure the narrative matches your clinical documentation and any supporting materials.