D2980 is a “crown” repair to a prosthetic not a filling in a natural tooth surface. It is to repair a material failure as in fracture. It would be any part of the crown.
If a filling is needed to repair decay below the crown’s margins, report the appropriate amalgam or composite code including a narrative such as example: “below the margin of the crown in the area of facial decay”.
A crown repair is subject to plan provision frequency limitation(5 to 10 years) as is a permanent filling restoration on the tooth(2 years or more).
If the tooth is to be part of a fixed bridge (say abutment on #29) in the near future it may be denied for #29 abutment coverage or reduced in coverage if the filling is covered based on the plan provision. ( If #29 gets a filling it is considered a permanent restoration.) This could result in the denial of this tooth as an abutment to a bridge because it has been restored.
Using a Palliative code is wrong because a palliative visit is not for definitive treatment such as a filling and involves addressing pain relief only. This code cannot be combined with any treatment code on the same date.
Question is: “Did they remove the crown, place a filling and recement? How extensive was the decay? Did they do a build-up(cannot bill for that with the crown repair code)or did they do a filling?
They bill for what they do and explain the plan limitations to the patient. Treatment plan in writing.
There are other codes to consider depending on the clinical notes such as D2940-Protective Restoration(with a narrative explaining the time it takes to do it, the reason and the expected time for the placement of the permanent restorative(fixed bridge).
eAssist Helpful News and Billing Tips; Edition #118
examiner
Can a composite filling on the (MB) be billed out to insurance on a crowned tooth?
Wendy Straube
What code would you use to fill the endo access hole in the crown?
Kimberly Spragins
What code do we use for a access closure on a crown after endo.
Thanks in advance
Jamie King
Hello Kimberly,
That is an excellent question. I believe that sealing an Endo opening would be described using a restoration code.
Conner Wilson
What code would we use for the placement of a post and core under an existing retainer crown of a bridge and placement of a composite to restore endo access to normal anatomy?
Jamie King
Hey Conner, thanks for leaving a comment on our blog! The proper code to describe the sealing of the access opening for a tooth with a crown after endodontic treatment would be a restoration code, usually a one surface composite. Use the appropriate amalgam or anterior/posterior composite code to describe this scenario. There should be a narrative provided with the claim explaining that this is a access opening closure after endo so the carrier will not deny as they have a crown on the patient’s hx. I hope this helps.
Jan
If the crown broken off too badly and is beyond to be repaired and a replacement has to be made, can this code still be used?
Jamie King
Hi Jan! Thanks for leaving a comment. One of our dental billing experts, Jackie has a response for you. She said, “No, because if the crown is too far gone to be repaired, you would not want to code for a repair. Best practices are to code what you do. Best of luck!!”
Nathan Vick
If there is decay at the buccal margin of crown, would this still be a crown repair? And I don’t do this often, but what if there was interproximal decay on a crown and one attempted to do a class II filling to avoid having to replace the crown? would this be a crown repair? Thanks