Dental implant technology and treatment protocols have grown dramatically in recent years. When they change, the procedures are often implemented before a CDT code (Code on Dental Procedures and Nomenclature) exists to describe them. Keeping up with the changes can be challenging for providers and their insurance billing staff.
Estela Vargas, CRDH.
Implantology is here to stay, as studies show that dental implants yield excellent long-term results, with 10-year success and survival rates above 95%. The reasons for implant failure are still being studied on several fronts.
Obtaining a detailed medical history and consulting a patient's physician is imperative to weigh the risk factors of implant failure. Smoking and a compromised immune system can increase implant failure, as do diabetes and osteoporosis. More thorough studies are needed to confirm an association.
Despite some failures, dental implants are generally a huge success story and have dramatically changed the lives of many. Until recently, most dental plans did not cover implants or related services. Now, many plans offer additional coverage for implants and associated services.
Some medical insurance plans will cover the cost of implant-related services if the policy provides benefits. This coverage may have limitations, and a least expensive alternative treatment clause may apply. Verifying dental plan benefits as part of the treatment plan presentation is a positive way to connect with patients about their financial responsibility.
The importance of documenting implant services for accurate billing
Documenting each component of dental implant services is necessary to create accurate patient records and ensure the highest possible reimbursement from dental plans. Precise documentation of each phase of treatment is also vital for ongoing patient care. Implant procedures that meet the definition of medical necessity are eligible for medical billing.
Many front-office business staff underuse medical billing because they lack the knowledge and training to code and bill correctly. Thus, keeping up with changes in the coding of implants and other dental services becomes crucial.
Common front-office duties in implant documentation and coding
Two front-office job duties requiring current knowledge and experience in documenting and coding patient records and dental claims are among the many responsibilities of the front-office manager or businessperson. They are:
- Working with the clinical team to ensure accurate and timely completion of insurance forms and patient billing records
- Documenting, filing, and follow-up of dental/medical claims to ensure claims adjudication and reimbursement
My challenge is guiding the dental team to learn the correct codes for their implant services, from diagnostic and testing to surgery, construction, and delivery.
FAQs about implant coding
My most requested coding inquiries concern implants and their related services. With growth come new codes and questions about how to implement these new codes into the fabric of implantology. For instance, in 2023, the ADA Code Maintenance Committee added four new implant services codes, including the following:
- D6105
- D6106
- D6107
- D6197
In 2024, two new codes were introduced:
- D6089
- D0396 (3D printing)
In 2025, the upcoming changes we are aware of include:
- Two amended implant codes, D6080 and D6081
- Editorial changes to other existing implant codes
- One new code will be announced by the ADA soon
Emerging trends in implantology
As treatment modalities become more complex, so do the documentation of patient records, coding of services, and billing of claims to insurance plans. Some of the newer implantology procedures that are trending include:
- 3D printing
- Digital impressions
- Immediate load implants
- Ceramic implants
- Nanotechnology for precise implant placement
- Augmented reality
- Antibacterial implant coatings
- Robot-guided implant surgery
Using CDT, ICD-10-CM, and HCPCS codes
CDT, the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM), and the Health Care Common Procedure Coding System (HCPCS) are among the dental codes used when billing claims for dental implants. The most common and recognizable CDT codes from the ADA cover various dental procedures in several categories, as described in the ADA's Current Dental Terminology manual.
ICD-10-CM (medical diagnostic) codes describe medical conditions that may impact the patient's oral health, such as oral injury or diseases. Dental implants and other implant-supported prosthetics are described using HCPCS codes. Some state Medicaid programs currently require ICD diagnosis codes to be reported on the 2024 ADA Dental Claim Form.
Implant clinical scenario: Coding for a socket-shield technique
To illustrate documentation of an implant clinical scenario and subsequent coding, I offer the following:
Clinical scenario
A 52-year-old man presents with a fractured maxillary right central incisor (tooth #8) that cannot be restored. The fracture's cause is unknown. The treatment plan includes immediate implant placement. A thorough clinical examination and radiographic analysis are negative for infection. The doctor chooses the socket-shield technique (SST) for extraction.
Procedure overview
- Local anesthesia is administered.
- Following the SST, the tooth is sectioned, and the buccal portion of the root is retained. The absence of infection is a critical factor in this case selection, as the technique relies on preserving the buccal root fragment to maintain the periodontal ligament and surrounding bone.
- The remaining tooth structure is carefully prepared, ensuring it stays intact to avoid unnecessary trauma to the surrounding tissues.
- An immediate implant is placed, allowing the root fragment to protect the buccal bone.
- The area is sutured, and post-op instructions are given.
Documentation
- Patient information: Age, medical history, chief complaint, and reason for extraction.
- Clinical findings: Document the extent of the fracture, the absence of infection, periodontal health, bone height and width, and diagnostic methods used to make these determinations, e.g., x-rays or computed tomography (CT) scans to confirm.
- Procedure description: Detail the steps of the socket-shield technique, including tooth sectioning, root retention, and implant placement. Indicate any intraoperative findings or complications.
- Post-operative instructions: Outline the patient's care instructions and any follow-up appointments.
- Informed consent: The patient understands the procedure and the associated risks (preserving the buccal root fragment), and the proposed benefits are well-documented.
- Clinical photos: If available, include pre-op, intra-op, and post-op images for clarity in documentation.
Coding
- D0140 -- Limited examination
- D0220 -- Periapical image of tooth #8
- D0364 -- Cone-beam CT capture and interpretation with limited field of view -- less than one whole jaw (if applicable)
- D7252 -- Partial extraction for immediate implant placement
- D6010 -- Surgical placement of an endosteal implant
- D6104 -- Bone graft at the time of implant placement (if applicable)
You can never be "caught up" on the latest trends in implantology or the yearly CDT coding changes. Still, you can be current by updating your coding books yearly, updating your dental software, and outsourcing to professional billers if you can't keep up.
Editor's note: References are available upon request.
Estela Vargas, CRDH, is the founder and CEO of Remote Sourcing, a dental insurance billing and revenue recovery service. She is a graduate of Miami Dade College's dental hygiene program. Vargas' extensive background in the clinical arena of dentistry is coupled with her experience as a practice administrator and business executive.
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
