Obturator Prosthesis Modification - CDT Code Guide
Overview
CDT code D5933 refers to the modification of an obturator prosthesis, which is a specialized dental appliance used to close defects such as those resulting from maxillofacial surgery or trauma. This procedure involves adjustments to an existing obturator, which may include relieving pressure on the denture base, enhancing the seal, or modifying peripheral areas to ensure proper separation between the nasal and oral cavities. These modifications are crucial for patient comfort and effective prosthesis function, particularly in cases where tissue changes occur post-surgery or due to healing processes.
When to Use This Code
- When a patient experiences discomfort due to tissue compression from an existing obturator.
- To improve the seal of an obturator for better separation between nasal and oral cavities.
- Following surgical procedures that alter the oral or nasal cavity structure, necessitating prosthesis adjustment.
- When interim or definitive obturators require modification for enhanced functionality.
- In cases where tissue changes have occurred, affecting the fit of the obturator.
Documentation Requirements
- Detailed patient history and clinical notes indicating the need for modification.
- Description of the specific modifications performed on the obturator.
- Pre- and post-modification assessment records.
- Photographic evidence of the obturator before and after modification, if applicable.
- Patient consent forms acknowledging understanding of the procedure.
- Insurance pre-authorization documentation, if required.
Billing Considerations
When billing for D5933, ensure that the modifications are clearly documented and justified in the patient's records. Be aware of any frequency limitations imposed by insurance providers, as some may restrict how often modifications can be billed. Common modifiers may include those indicating a change in the patient's condition or the necessity of the procedure. Verify coverage with the patient's insurance to avoid unexpected denials.
Related CDT Codes
Frequently Asked Questions
An obturator prosthesis is a dental appliance used to close defects in the maxillofacial region, often resulting from surgery or trauma.
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