HomeBlogAsk a Dental Billing & Coding Expert: Implant Code Cleanings

Ask a Dental Billing & Coding Expert: Implant Code Cleanings

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Francheska Diaz

Practice Booster

March 21, 2023 Dental Codes & Tips 7 min read

Straight from the hotlines of Code Advisor, it’s Ask a Dental Billing and Coding Expert! If you’re looking for updated insider information about how to best code your claims, you’ve come to the right place. This week, there seems to be a lot of interest surrounding how to properly code cleanings for patients with implants, including all on fours. Let’s take a detailed look at the answers to some of your coding questions:

Question:
We were using the code D6080 for inflammation around an implant, but we now noticed D6081 which is the correct code for this situation. Do you have a recommended price for this?

Answer: D6080 reports implant maintenance procedures for implant supported fixed prostheses and includes active debriding of the implant(s) and examination of all aspects of the implant system(s), including the occlusion and stability of the superstructure. D6080 is to be reported when fixed prostheses are removed, active debriding of the implants is performed and the prostheses are cleaned and reinserted. This code is indicated for fixed prostheses only (reported per prosthesis) and must include the removal of prostheses.  In addition, the patient is instructed in thorough daily cleansing of the implant(s).

D6081 reports scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surfaces, without flap entry and closure.  Note that D6081 cannot be performed in conjunction with a prophy, D4910, or D4346. It can, however, be reported in conjunction with D6080 as long as D1110, D4910, or D4346 are not completed. A prophy fee is a starting point for D6081. We don’t have fee data as the fee can be greatly variable. The price for all of these are dependent on the difficulty of the procedure and cost of materials. 

It should be noted that both D1110 and D1120 include removal of plaque, calculus, and stains from the tooth structures as well as implants and are intended to control local irrational factors.

Always code for what you do based on the most current CDT code set.

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Question:
Good afternoon.  We would like to know if there is a dental code for Implant prophylaxis.

Answer:
Both D1110 and D1120 include removal of plaque, calculus, and stains from the tooth structures
as well as implants and are intended to control local irrational factors.

Here are some scenarios beyond the scope of D1110 and D1120:

D6080 reports implant maintenance procedures for implant supported fixed prostheses and includes active debriding of the implant(s) and examination of all aspects of the implant system(s), including the occlusion and stability of the superstructure. D6080 is to be reported when fixed prostheses are removed, active debriding of the implants is performed and the prostheses are cleaned and reinserted. This code is indicated for fixed prostheses only (reported per prosthesis) and must include the removal of prostheses.  In addition, the patient is instructed in thorough daily cleansing of the implant(s).

D6081 reports scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surfaces, without flap entry and closure and a bony defect is not present.  Note that D6081 cannot be performed in conjunction with a prophy, D4910, or D4346. It can, however, be reported in conjunction with D6080 as long as D1110, D4910, or D4346 are not completed. A prophy fee is a starting point for D6081–we don’t have fee data as the fee is greatly variable. Talk with the dentist/hygienist as to the fee based on the time spent.

For the edentulous patient who has implant/abutment supported removable dentures, report the cleaning around the implant abutments as D6199–unspecified implant procedure, by report. If the removable denture is inspected by the dentist and cleaned then report D9932–cleaning and inspection of the removable complete denture, maxillary or D9933–cleaning and inspection of the removable complete denture, mandibular.

D9110–palliative treatment of dental pain-per visit can be reported if a patient presents for an emergency visit reporting pain around an implant and implant debridement is indicated and performed. This would include any necessary follow-up by subsequent visits. Include a narrative on the claim form which documents necessity reflected in the clinical notes. D9110 reimbursement is variable and may be classified by payors as either preventive or basic.

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If surgical intervention is required:

D6101 is used to report debridement of the area around an existing implant with peri-implantitis and includes reflecting a surgical flap for access to the area of the defect(s) as well as the closure of the surgical flap once the debridement is completed. If D6101 is performed less than a year after the implant has been placed, it is unlikely to be considered for reimbursement yet should still be reported.

D6102 is similar to D6101 yet includes osseous contouring of a peri-implant defect(s) and includes reflecting a surgical flap for access to the area of the defect(s) as well as the closure of the surgical flap once the debridement is completed. If D6102 is performed less than a year after the implant has been placed, it is unlikely to be considered for reimbursement yet should still be reported. If a bone graft is placed in the area around an existing implant where a bony defect exists, report D6103 in addition to D6102. Membranes placed for guided tissue regeneration would be reported as D6106 if resorbable or D6107 for nonresorbable.

Note: D4341/D4342 for scaling and root planing is indicated for natural teeth only, and does not include implant debridement.

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Question:
Can I report D1110 and D6080 when cleaning around a single implant during a prophylaxis?

Answer:
D1110 includes the removal of plaque, calculus, and stains from the tooth structures as well as implants, intended to control local irrational factors.

D6080 reports implant maintenance procedures for implant supported fixed prostheses and includes active debriding of the implant(s) and examination of all aspects of the implant system(s), including the occlusion and stability of the superstructure. D6080 is to be reported when fixed prostheses are removed, active debriding of the implants is performed and the prostheses are cleaned and reinserted. This code is indicated for fixed prostheses only (reported per prosthesis) and must include the removal of prostheses. 

In addition, the patient is instructed in thorough daily cleansing of the implant(s). If completed in conjunction with prophylaxis of a natural tooth, you may report both D1110 and D6080 on the same service date. However, D6080 may be considered part of the prophylaxis service by some payers. Without an implant rider, D6080 is seldom reimbursed when reported alone or in conjunction with D1110.

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Question:
How should we charge for a cleaning when the patient has a full upper denture and lower natural teeth?

Answer: 
If the removable denture is inspected by the dentist and cleaned then report D9932–cleaning and inspection of the removable complete denture, maxillary. For the natural teeth on the lower arch, report D1110. Most offices would charge the full fee for the prophy, despite only cleaning one arch and “throw in” cleaning the denture at no charge. This would be the best approach insurance-wise.

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Looking for more billing and coding answers? We have them at Practice Booster! Supercharge your billing and coding knowledge with industry-leading resources like Code Advisor, your one-stop-shop for the newest CDT codes. Looking for a way to access this juicy insider knowledge on the daily? Practice Booster’s online code library gives you 24/7 access to tips, narratives, flowcharts, videos, articles and moreEnrollment in the eAssist Dental Billing platform grants you complimentary access to Code Advisor, and it’s as easy as scheduling a consultation below. Already an eAssist client? Log in today and get the industry’s leading coding resources at your fingertips.

Fran 3

By Francheska Diaz

Practice Booster

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