Facial Prosthesis - CDT Code Guide
Overview
CDT code D5919 refers to the creation and fitting of a facial prosthesis, a specialized removable device designed to replace a portion of the face lost due to surgery, trauma, or congenital absence. This prosthesis plays a crucial role in restoring both function and aesthetics for patients who have experienced significant facial tissue loss. The procedure involves careful customization to ensure that the prosthesis matches the adjacent skin and adapts to natural tissue movements. Challenges such as salivary leakage, especially when the prosthesis communicates with the oral cavity, can affect retention and require precise adjustments. Dental professionals must consider these factors to provide optimal care and support for their patients.
When to Use This Code
- Post-surgical reconstruction following tumor removal in the facial region
- Trauma cases resulting in significant facial tissue loss
- Congenital absence of facial structures requiring prosthetic intervention
- Patients experiencing difficulty with retention due to salivary leakage
- Situations where natural tissue flexion complicates prosthesis adaptation
Documentation Requirements
- Detailed patient history and diagnosis justifying the need for a facial prosthesis
- Comprehensive treatment plan outlining the prosthesis design and materials used
- Clinical notes on the fitting process and any adjustments made
- Patient consent forms acknowledging the procedure and potential outcomes
- Photographic documentation of the affected area before and after prosthesis placement
- Records of follow-up visits to monitor prosthesis adaptation and patient satisfaction
Billing Considerations
When billing for D5919, it's important to note any frequency limitations imposed by insurance providers, as maxillofacial prosthetics can be subject to specific coverage criteria. Common modifiers may include those indicating the initial placement or adjustments. Ensure that documentation supports the medical necessity of the prosthesis to facilitate insurance approval and reimbursement.
Related CDT Codes
Frequently Asked Questions
Facial prostheses are commonly made from medical-grade silicone due to its durability and ability to mimic natural skin texture and color.
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