D6200 – D6999 Prosthodontics, Fixed
By Teresa Duncan, M.S.
Fixed prosthodontics replace missing teeth using fabricated materials that are cemented into onto existing natural teeth or roots. A dentist can choose from replacing missing teeth with an implant, fixed bridgework or removable partials and dentures. When treatment planning for fixed prosthodontics, it is important to remember that multiple appointments and procedures are usually required. Clinicians must take into account the patient’s oral health habits along with existing restorations in order to determine if a fixed prosthetic is the best choice.
Patients are often confused by the terminology used when discussing fixed prosthodontics. A treatment coordinator may be referring to a fixed partial denture between teeth #13 and 15, but the patient may not understand that this is the same as fixed bridgework. With implant and fixed restorations, it is helpful to have visual aids and even tangible examples on hand. Often the only time the patient has even seen a bridge or fixed partial denture is right before it is cemented into his or her mouth.
From the beginning, your team should use the same language when discussing the components of fixed prosthodontics. They should also keep in mind that although most fixed prosthodontics are cemented permanently there can be situations in which the practitioner will choose to do so temporarily.
Retainer: For years the retainer was referred to as the “abutment” but as implant usage and coding has evolved, it has shifted away from that. A retainer acts as a stabilizer for the prosthodontic.
Abutment: When discussing fixed prosthodontics, the abutment is the part of the tooth upon which the retainer will seat.
Pontic: An artificial tooth created to take the place of a missing tooth. It will be attached to retainers. There is no supporting tooth or root below it. It may rest against but is not meant to be supported by the soft tissue.
Connector: The part that unifies the pontic and the retainer.
Fixed Partial Denture: A laboratory fabricated prosthetic that replaces missing teeth or empty tooth spaces. It is meant to stabilize the bite and maintain arch integrity. This means that it prevents teeth from shifting and changing the patient’s bite which can lead to future required treatment. Also referred to as fixed bridgework or a bridge.
Cantilever Bridge: A fixed partial denture (bridge) in which a stabilizing retainer is not present on one end.
Changes to This Category
There are no changes in CDT 2018. CDT 2017 also had no changes.
Diagnosis Codes – ICD-10-CM
The CDT to ICD tables in Appendix 1 provide appropriate guidance on linkages between “Prosthodontics, fixed” procedure codes and diagnosis codes.
Note: Fixed prosthodontics services are typically not reimbursable under medical plans. If it is necessary to cross-code these services, then the diagnosis for tooth loss, oral condition or any systemic conditions should be referenced.
CODING SCENARIO #1
A patient presents with tooth #27 missing and the doctor learned that this tooth has been missing for under a year, and also observed that teeth #26 and 28 appeared to be in good condition. Upon further evaluation the doctor determined that #26 would not provide enough retention for a Maryland bridge and was reluctant to incorporate a virgin tooth in the prosthetic.
The patient was presented the information regarding Maryland bridge replacement and cantilever bridge replacement. The doctor recommended a cantilever bridge to preserve tooth structure for #26. Patient reviewed the informed consent and opted to move forward with a cantilever bridge replacement.
What codes are used to document and report this procedure?
Tooth #28 is a retainer and the applicable code is:
D6750 retainer crown – porcelain fused to high noble metal
Note: Retainers are differentiated by their material. Examples include:
• D6751 retainer crown – porcelain fused to predominantly base metal
• D6752 retainer crown – porcelain fused to noble metal
• D6780 retainer crown – 3/4 cast high noble metal
(Refer to CDT 2018 for the applicable code based on the material.)
The pontic code for a “cantilever” bridge are the same as a conventional bridge, which for tooth #27 would be:
D6240 pontic – porcelain fused to high noble metal
As with the retainers, pontics may be made of different material. Always refer to CDT 2018 to use the appropriate code.
A “Maryland” Bridge
A patient suffered an accident that damaged the dentition as follows:
• Two teeth were lost – #23 and #24
• One tooth was broken – #26
The doctor determined that #26 could not be restored and required extraction.
The initial treatment plan involved implants, which the patient declined due to cost. An alternative treatment plan was accepted. This alternative involved a “Maryland” bridge as this would preserve the remaining teeth and retain the option of implant in the future. The “Maryland” bridge consisted of a resin bonded porcelain-fused-to-metal (noble) bridge from teeth #22 to #27 with #25 acting as a pier.
What codes are used to document and report this procedure?
Teeth #22, 25 and 27 become retainers and the applicable code is:
D6545 retainer – cast metal for resin bonded fixed prosthesis
Note: Resin bonded bridge retainers (often referred to as wings) are differentiated by their material:
• All cast metal or porcelain fused to metal bridges would utilize the D6545 code noted above.
• The porcelain/ceramic retainer code (D6548) could only be used with a porcelain/ceramic pontic.
• Should the retainer be fabricated out of resin/composite, the applicable CDT code is D6549 resin retainer – for resin bonded fixed prosthesis.
The pontic codes for a “Maryland” bridge are the same as a conventional bridge, which for teeth #23, 24, and 26 would be:
D6242 pontic – porcelain fused to noble metal