Resection Prosthesis Max Partial - CDT Code Guide
Overview
CDT code D5940 refers to the procedure of creating a maxillary partial removable resection prosthesis. This specialized dental appliance is designed for patients who have undergone surgical resection of the maxilla due to conditions such as cancer, trauma, or congenital defects. The prosthesis helps restore oral function, aesthetics, and speech by replacing the missing portions of the maxilla. Typically, this procedure is part of a comprehensive treatment plan that involves collaboration between oral surgeons, prosthodontists, and other dental specialists. The resection prosthesis is custom-made to fit the unique anatomical changes of the patient's mouth, ensuring comfort and optimal functionality.
When to Use This Code
- Post-surgical rehabilitation following maxillary resection due to cancer.
- Restoration of oral function after trauma-induced maxillary loss.
- Replacement of congenital maxillary defects.
- Support for speech and mastication in patients with partial maxillary resection.
- Aesthetic restoration for patients with significant maxillary tissue loss.
Documentation Requirements
- Detailed surgical report outlining the extent of maxillary resection.
- Comprehensive patient history and diagnosis leading to the need for resection prosthesis.
- Clinical notes detailing the custom design and fitting process of the prosthesis.
- Photographic documentation of the maxillary defect and prosthesis fitting.
- Patient consent forms acknowledging understanding of the procedure and expected outcomes.
Billing Considerations
When billing for D5940, ensure that the procedure is documented as medically necessary due to maxillary resection. Be aware of any frequency limitations imposed by insurance providers, as this is typically a one-time procedure following significant surgical intervention. Common modifiers may include those indicating the specific quadrant or extent of the prosthesis. Verify with insurance carriers regarding coverage specifics, as this procedure may require pre-authorization.
Related CDT Codes
Frequently Asked Questions
A resection prosthesis is a custom-made dental appliance designed to replace missing parts of the maxilla following surgical resection, restoring function and aesthetics.
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