Reasons for Claim Denials Related to “D2950” Dental Core Buildup Code

Hi, this is Amber Darst, Dental Insurance Coordinator from Managed Outsource Solutions. The core buildup code in dental insurance can cause some confusion. I’m going to be discussing a little bit why the D2950 dental core buildup code faces so many claim denials.

Billing for a core buildup (D2950) is often a challenge. Being an experienced Dental Insurance Coordinator, I have a strong feeling that there may be some dental practices that still don’t quite understand when it is appropriate to bill or not to bill for a buildup.

So let us get a little understanding of what the core buildup procedure is. Core buildup is placing restorative material that builds up inadequate structure and is often times 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 of the original tooth left to support 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. And of course it is crucial that whether the coverage exists or not, the most accurate code is to always be reported.

So, why do insurers deny the D2950 code?

Insurers may 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 or
• if the procedure involves a clean or ideal crown prep with plenty of tooth structure intact to support the crown
• if the claim lacks a benefit narrative from the dental office. An increasing number of dental carriers are recognizing the medical nature of certain dental procedures. So, all dental practices should document dental-medical necessity routinely to help optimize dental benefit coverage and cross-coding opportunities or
• if the code is over utilized. In many claims, the D2950 code will be mixed with thousands of other claims resulting in “overutilization” of the procedure. When a code is used too much, it is frequently dropped from insurance plans, leading to denials.

So, we discussed when to use the D2950 code.

Here is another code to consider when you are not looking at insufficient tooth structure to support a crown. This would be the D2949 code. The CDT descriptor for this code is “Placement of restorative material to yield a more ideal form, including the elimination of undercuts.”This code describes a procedure where restorative material is placed in the tooth for purposes other than helping a new crown stay on such as 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.

So here are a few tips to minimize claim denials for core buildup

• First, all is to make sure to provide clear documentation of the condition that resulted in the buildup in the initial claim submission. Make sure that documentation indicates that the tooth was broken down to the extent that a buildup was necessary
• Also, provide supporting details along with the claim. Claim approvals from payers for core buildup require supporting X-rays. Attaching pre-op photos of the tooth along with the claim also gives a better idea of how much decay existed before the procedure.
• And of course post-op X-rays showing the buildup in places are also necessary for claim approval

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.

Reference the original claim number and add any additional X-rays or documentation that may further support your claim appeal request.

I hope this helps, but always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thanks for listening in!