Coding Tip: D2950 Core Build-up Debunked

D2950

Coding Tip: D2950 Core Build-up Debunked

This code is overused and misused in many situations.  To understand it’s true application read the definitions from Coding with Confidence by Charles Blair, DDS   http://drcharlesblair.com/

According to Dr. Blair “A core build-up(no longer called crown build-up) must be necessary for crown retention to be considered a build-up.  The core build-up should rebuild the internal anatomy of the tooth structure as prepared for a crown. Many payers will not cover a build-up unless there is a crown being placed or will not pay for the build-up without the seat date of the crown provided.   Often a core-build-up is reimbursed for a crown placed after endodontic seal because it is common for severe loss of tooth structure from decay.

Dental Billing Tips and News for Pros; Edition #131

5 Comments
  • Jillian P
    Posted at 23:46h, 09 January Reply

    Great info for when the office team is unsure about billing a core build up!

  • J Rodely
    Posted at 10:33h, 28 January Reply

    My experience is that insurance companies consider the “build-up to be part of the overall crown prep procedure” therefore not allowing any additional benefit for the build-up code. Any suggestions when this is the case?

    • Jaycee Brown
      Posted at 21:42h, 28 January Reply

      Hi J Rodely, some of our eAssisters have answers for you!

      “By definition, the core buildup is a separate procedure from the crown and should always be paid as long as there’s evidence for necessity.” -Estela
      “You mostly see those denials when the build and prep are submitted same day. Many times if you contact the insurance and let them know the seat date was actually later on and give them the date they will reprocess the buildup because both procedures did not actually take place the same day.” – Stefanie
      “A core buildup, as long as it was necessary, will in most cases be covered by insurances with no issues at all. I always include a narrative and state that the buildup was done separate from the crown preparation because (stat reason- for example “there was insufficient tooth structure once decay and old broken restoration was removed”) and always add to that narrative that the “buildup was needed for retention of crown”, along with the crown prep date and crown seat date.” – Cheri
      “When you present the treatment and need for treatment, you should clarify when the prep was complete and the delivery was complete this allows for the separate benefit for D2950.” – Jackie

      Hope this helps!

  • Michelle Cousins
    Posted at 15:34h, 25 March Reply

    We just learned that we can’t bill the buildup and crown on the same day. Anyone else having this issue?

  • Amy Shreves
    Posted at 16:48h, 07 November Reply

    What do you do if the patient does not have the money for the crown right now or they say they will be back for the crown but never come back. If they want he seat date, it never happened?

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