When is D8695 used?
The D8695 dental code applies to removing fixed orthodontic devices when treatment ends early, not upon successful completion. This CDT code becomes necessary when patients require premature removal of braces or similar fixed appliances due to various circumstances including medical issues, patient moving, financial difficulties, or treatment non-compliance. Note that D8695 is not appropriate when removal occurs as part of normal, completed orthodontic care; different codes apply in those situations, such as D8680 for orthodontic retention procedures.
D8695 Charting and Clinical Use
Proper documentation remains critical when using D8695. Clinical records must clearly explain why early appliance removal became necessary, including relevant patient background, communications, and supporting evidence (such as medical advice, patient requests, or financial documentation). Typical situations include:
Medical requirements: Patient experiences conditions (such as serious oral infections, material allergies) requiring immediate appliance removal.
Patient moving: Patient relocates and cannot continue treatment at the current practice.
Treatment non-compliance: Patient fails to follow treatment guidelines, making continued orthodontic care impractical.
Financial constraints: Patient cannot continue paying for ongoing orthodontic treatment.
Always maintain comprehensive progress notes, patient consent documentation, and relevant correspondence supporting the removal decision. This complete documentation proves essential if claims face review or denial by insurance companies.
Billing and Insurance Considerations
When filing claims for D8695, recommended practices include:
Coverage verification: Check with the patient's insurance to determine if D8695 receives coverage and whether pre-authorization is necessary.
Complete claim documentation: Include clinical notes, patient correspondence, and supporting materials with the claim. Clearly state the early removal reason in the narrative portion.
EOB review: Carefully examine Explanation of Benefits documents for payment status or denial explanations. For denials, check for missing information or request peer-to-peer reviews when suitable.
Appeals handling: When claims get denied, quickly file appeals including additional documentation and thorough explanations of medical necessity or other qualifying factors.
Maintaining proactive and systematic billing practices will decrease accounts receivable time and enhance claim approval rates.
How dental practices use D8695
Case: A 15-year-old patient wearing fixed braces experiences ongoing oral allergic reactions to the appliance components. Following consultation with the patient's doctor and orthodontist, early appliance removal becomes necessary. The dental practice records the allergy diagnosis, includes physician correspondence, and secures written guardian consent. The D8695 claim submission includes all supporting materials, and the insurance company approves payment after confirming medical necessity.
This case demonstrates how thorough documentation and clear communication with patients and insurance providers ensures successful D8695 dental code usage.
Common Questions
Can D8695 be billed together with other orthodontic procedure codes?
Yes, D8695 may be billed with other procedure codes when additional services are rendered during the appliance removal appointment. It's essential to document each procedure separately and avoid incorrect bundling. For instance, if a comprehensive oral evaluation (D0120) is conducted during the same visit, both codes can be billed provided they are medically necessary and properly documented.
How many times can D8695 be billed for one patient?
Generally, D8695 should be billed only once per orthodontic case since it represents the removal of fixed appliances prior to treatment completion. Multiple billings for the same patient and appliance may trigger insurance scrutiny and result in claim denials or audits. Always review payer-specific policies for any potential exceptions.
What causes insurance companies to deny D8695 claims?
Frequent denial reasons include inadequate documentation, absence of clear clinical justification for premature removal, missing supporting documentation (like radiographs or clinical narratives), or the procedure not being covered under the patient's insurance plan. Comprehensive documentation and coverage verification prior to the procedure can help minimize denial risks.