How often can D5422 be billed?

Frequency depends on the patient's insurance policy; check with the provider for specific limitations.

Can D5422 be billed with a new partial denture placement?

Adjustments are typically billed separately unless included in the initial placement package. Verify with the insurance policy.

What documentation is needed for insurance claims?

Include detailed notes on the adjustment, patient symptoms, and any changes in oral anatomy affecting the denture fit.

Is patient consent required for denture adjustments?

Yes, obtaining and documenting patient consent is essential for compliance and patient understanding.

D5422

Adjust Partial Denture Mandibular - CDT Code Guide

Prosthodontics, removable/Adjustments to Dentures

Overview

CDT code D5422 refers to the adjustment of a mandibular partial denture. This procedure is typically performed when a patient experiences discomfort or improper fit of their lower partial denture. Adjustments may involve modifying the denture base, clasps, or teeth to improve fit and function. Dental professionals often perform this procedure to alleviate sore spots, improve chewing efficiency, or accommodate changes in the patient's oral anatomy. Understanding the nuances of this code is crucial for ensuring optimal patient care and accurate billing.

When to Use This Code

When a patient reports discomfort or sore spots due to a mandibular partial denture.
To improve the fit of a mandibular partial denture after initial placement.
When changes in the patient's oral anatomy affect the fit of the denture.
Following dental extractions or other oral surgeries that impact denture fit.
To adjust the occlusion of a mandibular partial denture for better function.

Documentation Requirements

Detailed notes on the patient's symptoms and reasons for adjustment.
Description of the specific adjustments made to the denture.
Patient's consent and understanding of the procedure.
Before and after photos or impressions if applicable.
Record of any follow-up appointments scheduled for further adjustments.

Billing Considerations

When billing for D5422, ensure that the adjustment is medically necessary and documented thoroughly. Frequency limitations may apply, so check with the patient's insurance provider. Common modifiers include those indicating the specific quadrant or arch involved. Be aware of any insurance-specific guidelines that may affect reimbursement.

Related CDT Codes

D5410 D5411 D5421 D5130 D5140

Frequently Asked Questions

D5421 is for adjusting a maxillary partial denture, while D5422 is for a mandibular partial denture.

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