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Gaining in rapid popularity are these so-called “mini-implants.” They are sometimes referred to as “small” or “narrow diameter,” depending on the precise dimensions as well as specific manufacturer. The more traditional versions had a simple “ball and socket” female O ring configuration requiring no such separate abutment.
From the coding, billing, and reimbursement perspective, let’s separate the global procedure into its 2 major subcomponents. They are the implant and the existing denture that is now being modified to become an overdenture.
The Implant
Procedure code D6010 identifies the surgical placement of the implant body. Of question would be the separate billing and reimbursement for the surgical implant indexes. Procedure code D6190 identifies the fabrication and use of these separate presurgical guides. Most all benefit plans will consider the fabrication and use of such guides as being part of the more global surgical placement of the implant body and will not accept its coding for separate as well as additional reimbursement. In the absence of a definitive narrative report specifying why such an index device is above and beyond the routine delivery of the implants, surgical placement separate reimbursement should not be expected.
The Prosthetic
When the techniques involved in the modification of an existing removable denture to one becoming an implant-retained overdenture, they are globally identified with procedure code D5875. A weakness in the existing coding sequence is that code D5875 does not specify if the original removable appliance replaces either a partial or completely edentulous arch. Also the fact that this code, by ADA definition, does not require a “by report” clinical narrative makes claim delay inevitable. That is why I always recommend that the code always be submitted with a description of the prosthetic modification along with the original date of placement and anticipated longevity.
If the final appliances are removable by the patient, they are classified as overdentures—be they complete (D6053) or partial (D6054). Implant supported connecting bars are coded and billed as D6055 while the attachment portion within the overdenture is not separately identified as it is part of the fee for the final appliance.
Fee Data
As concerns the codes discussed, remember that the prosthesis modification (D5875) and surgical index (D6190) are only billed and identified once for the series of visits. The surgical placement of the implant (D6010) as well as the prefabricated abutment (D6056) are billed and identified per implant.
In reviewing thousands of claims for multiple implant placements during the same surgical series, it is not uncommon to find documentation and billing based upon the premise of the “single incision rule.” This type of billing generally results in the first implant being billed at 100% of the fee while each additional at the same surgical visit being billed at some variation of 80%, 60%, all the way down to 40% of the fee for the first surgically placed implant.
How you bill in your office is between you, your patients, and their individual benefit plans as long as everyone is billed the same. No variation (Table).
| Table. Small-diameter Implant code and Fee Data |
| Code |
Description |
Low |
Medium |
High |
USA
Average |
USA
RV |
| D5875 |
Modification of removable prothesis following implant surgery |
$300 |
$331 |
$580 |
$407 |
9.69 |
| D6010 |
Surgical placement if implant body: endosteal implant |
$1,565 |
$1,740 |
$2,190 |
$1,953 |
46.50 |
| D6054 |
Implant/abutment supported removable denture for partially edentulous arch |
$1,310 |
$1,520 |
$2,180 |
$2,300 |
47.21 |
| D6056 |
Prefabricated abutment—uncludes placement |
$468 |
$559 |
$620 |
$550 |
13.10 |
| D6190 |
Radiographical/surgical implant index, by report |
$199 |
$300 |
$400 |
$293 |
6.98 |
These data represent 100% of the 90th percentile. The relative value is based upon the national average and not the individual columns of broad-based data. The abbreviated code numbers and descriptors are not intended to be a comprehensive listing.
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Drsumitra