Orbital Prosthesis - CDT Code Guide
Overview
CDT code D5915 refers to the fabrication of an orbital prosthesis, a specialized dental procedure that involves the creation of a prosthetic device to restore the eye, eyelids, and adjacent tissues lost due to trauma or surgery. This procedure is crucial for patients who have undergone significant facial surgery or experienced trauma that resulted in the loss of the orbital area. The process begins with the creation of an original mold, which can be used to fabricate additional prostheses as needed, provided there are no further changes in the patient's tissue. This ensures a long-term solution for restoring facial aesthetics and function, enhancing the patient's quality of life.
When to Use This Code
- Patients who have lost an eye and surrounding tissue due to trauma.
- Cases where surgical removal of the eye and adjacent structures was necessary.
- Patients requiring replacement of an existing orbital prosthesis due to wear or damage.
- Situations where a new prosthesis is needed from an existing mold.
- When there are no further changes in the patient's tissue, allowing for the use of the original mold.
Documentation Requirements
- Detailed clinical notes describing the trauma or surgical procedure leading to the loss.
- Photographic evidence of the affected area before and after prosthesis placement.
- Documentation of the mold creation process and materials used.
- Patient consent forms for the procedure and use of the prosthesis.
- Records of any previous prostheses and their condition.
- Insurance pre-authorization if required by the patient's plan.
Billing Considerations
When billing for D5915, it is important to note that insurance coverage may vary, and pre-authorization might be necessary. Frequency limitations often depend on the patient's specific insurance plan, and common modifiers may include those indicating the replacement of an existing prosthesis. Ensure that all documentation is thorough to avoid claim denials.
Related CDT Codes
Frequently Asked Questions
An orbital prosthesis is a custom-made device designed to replace the eye and surrounding tissues lost due to trauma or surgery.
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