Resection Prosthesis Max Complete - CDT Code Guide
Overview
CDT Code D5938 refers to the procedure for creating a maxillary complete removable resection prosthesis. This specialized dental appliance is designed for patients who have undergone significant maxillary resection, often due to cancer surgery or trauma. The prosthesis replaces missing oral structures, restoring function and aesthetics. It is custom-made to fit the patient's unique anatomy, ensuring comfort and effective rehabilitation. Typically, this procedure is part of a comprehensive treatment plan involving oral surgeons and prosthodontists, aiming to improve the patient's quality of life by enabling normal speech, chewing, and appearance.
When to Use This Code
- Patients who have undergone maxillary resection due to cancer surgery.
- Individuals with traumatic injuries resulting in significant maxillary loss.
- Cases where congenital defects have led to maxillary deficiencies.
- Patients requiring rehabilitation of oral function and aesthetics post-surgery.
- Scenarios where a complete removable prosthesis is preferred over fixed options.
Documentation Requirements
- Detailed patient history and diagnosis justifying the need for a resection prosthesis.
- Comprehensive treatment plan outlining the prosthetic design and expected outcomes.
- Pre-operative and post-operative photographs for clinical records.
- Documentation of consultations with oral surgeons and prosthodontists.
- Patient consent forms acknowledging understanding of the procedure and its implications.
- Detailed notes on the fabrication process, including materials used and fitting sessions.
Billing Considerations
When billing for D5938, ensure that the procedure is documented as medically necessary due to maxillary resection. Check for frequency limitations, as insurance may only cover this procedure once per lifetime or under specific conditions. Common modifiers include those indicating bilateral procedures or complications. Verify with the patient's insurance provider for coverage specifics, as policies may vary significantly.
Related CDT Codes
Frequently Asked Questions
A resection prosthesis is a dental appliance designed to replace missing oral structures after maxillary resection, restoring function and aesthetics.
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