Billing for a core buildup (D2950) is often a challenge. Being an experienced Dental Insurance Coordinator, I have a strong feeling that most dental practices don’t even know when it is appropriate to bill or not for buildup. Dental practices also have to take effort to make their patients understand the limitations of their plan prior to treatment to avoid any further issues. So, here are some details on the topic which would be helpful to dentists as well as dental billing companies.
Dentists perform buildup procedure when it is necessary prior to restoring a tooth with a crown. The purpose of a buildup is to help hold the crown on when there is not enough tooth structure left to hold the crown. While certain carriers reimburse patients for buildups only in cases of previous endodontic treatment, some will provide a benefit if the remaining anatomical tooth structure can be described as less than 50 percent and inadequate to provide proper crown retention. It is crucial that whether the coverage exists or not, the most accurate code is reported.
Why Insurers Deny CDT code D2950
Insurers will not reimburse for buildup –
- if the procedure is billed on the same day as a root canal, as it will be considered inclusive of the root canal fee
- if the procedure involves a clean or ideal crown prep. If a posterior tooth undergoes endotherapy, the restorative dentist would then perform a pre-fab post and core (D2954) or indirect post and core (D2952). The most common is the pre-fab post and core (D2954). Payers will usually reimburse for a D2954 even if you bill for an Indirect post and core (D2952).
- if the claim lacks a benefit narrative from the dental office. Benefit narratives are concisely written dental-medical necessity statements to prove why the care was performed. An increasing number of dental carriers are recognizing the medical nature of certain dental procedures. All dental practices should document dental-medical necessity routinely to help optimize dental benefit coverage and cross-coding opportunities. According to Dentistry iQ, the narrative might read like, “Endodontically treated xx/xx/xx. 65% tooth structure missing. Needed for crown retention.”
- if the code is over utilized. In many claims, D2950 code will be mixed with thousands of other claims resulting in “overutilization” of the procedure. When a code is used too much or over utilized, it is frequently dropped from insurance plans, leading to denials. Make sure not to use this code for fillers (see D2949) or bases (included in restorative procedure itself).
Other buildup codes – D2952 and D2954
D2952 is Cast Post and Core, in Addition to Crown. It differs from D2950, which refers to a laboratory cast post that is cemented into an endodontically treated tooth to build up the anatomical crown prior to a crown preparation. Core material also is used. However, most carriers will not pay for a D2952 and a D2950 on the same tooth.
D2954 is Prefabricated Post and Core, in Addition to Crown. This procedure includes the core material and the code describes a “store-bought” post that is typically used to build up an endodontically treated tooth. Claims using this code should include a narrative noting that the tooth has been endodontically treated and that less than 50 percent of the tooth structure is remaining.
D2950 vs. D2949
Based on CDT 2014 descriptor, D2950 “Refers to building up of coronal structure when there is insufficient retention for a separate extracoronal restorative procedure.” According to ADA, Core Buildup, Including Any Pins is referred to building up of the anatomical crown when a restorative crown will be placed, whether or not pins are used.
The core buildup (D2950) is commonly used incorrectly by many practices. The code (D2950) usually applies to teeth that do NOT have enough tooth structure to support a crown. Typically, 60% or more of the tooth is missing.
D2949 is a new code in CDT 2014.
- D2949 – Restorative Foundation
CDT descriptor for D2949 is “Placement of restorative material to yield a more ideal form, including elimination of undercuts.” This code describes a procedure where restorative material is placed in the tooth for purposes other than helping the new crown stay on. This procedure is often incorrectly submitted as a D2950 buildup.
The procedure might include blocking out undercuts so impressions are easier to take, filling in voids in the prep, eliminating a box form, filling in a concavity or even making the shape of the prepped tooth more “ideal” in contour.
Tips to Minimize Claim Denials for Core Buildups
It has been recommended that to minimize claim denials for core buildups,
- Provide clear documentation of the condition that resulted in the buildup in the initial claim submission. Make sure that the documentation indicates that the tooth was broken down to the extent that a buildup was necessary to perform the endodontic procedure.
- Provide supporting details along with the claim. Claim approvals from payers for core buildup require supporting X-rays. Attaching photos of the tooth being treated along with the claim also gives a better idea of how much decay existed, and it helps to speed up claim approvals.
- Submit an endo prognosis, a well-detailed narrative, and pre- and post-op radiographs to prove clinical necessity. Radiographs and intraoral photographs can be submitted as part of a narrative to the insurance carrier.
In cases of denial, the dental office must submit an appeal outlining the reasons for the procedure, leading to improved prognosis. Proper denial management is critical. A proper appeal involves sending the payer a written request to reconsider the claim. Additional documentation including radiographic evidence or a narrative description should be included to give the carrier a clearer picture of why the treatment was recommended.