Question

We placed a cantilever bridge on a patient, and I do not know what code to use on the claim form. Do I need to include a narrative? I am new to dentistry and am not familiar with some of the procedures I am billing.

You probably know that a conventional three-unit bridge (a.k.a. fixed partial denture) includes a pontic to replace the missing tooth supported by a retainer crown on either side. While some practices still refer to the retainer crown as an “abutment,” the correct term with regard to coding is “retainer crown.”

A cantilever fixed bridge is one in which only one side of the pontic is attached to a retainer crown. Cantilever bridges can be used to replace anterior teeth or posterior teeth.

Cantilevers may be selected because they save tooth structure, are easier to clean, provide better esthetics, or because the patient does not want an implant. Another reason a patient may opt for a cantilever bridge is because they are typically less expensive to fabricate than a conventional three-unit bridge, which always involves atleast two retainer crowns.

Cantilever bridge examples:

If tooth #7 is missing, a cantilever bridge may be placed instead of a three-unit bridge from 6-8. For example, a retainer crown may be placed on tooth #6 and tooth #7 replaced with a pontic.

As another example, a cantilever bridge may be an option when #15 and #16 are missing in the posterior. Retainer crowns could be placed on #13 and #14 and a pontic attached to replace #15, which may be needed to prevent the supereruption of #18.

Coding a cantilever bridge

A cantilever bridge involves the same codes as a conventional three-unit bridge, except that the pontic is only attached to a retainer crown on one side. So, unless the cantilever has two retainer crowns on one side (i.e., double abutted), only one retainer crown is coded. Narratives are seldom needed, other than to identify when the missing tooth was lost or extracted. Benefits will be affected by the following:

  • The endodontic and periodontal health of the retainer tooth/teeth,
  • The existence of a missing tooth clause, which excludes payment for the replacement of teeth missing prior to coverage under the current pla
  • The existence of a waiting period for major services,
  • A prosthetic replacement clause if this is not initial placement,
  • The existence of a least expensive alternate treatment (LEAT) clause, which may trigger an alternate partial benefit if more than one tooth is missing in the arch, and/or
  • The patient’s remaining plan maximum.

Be sure to indicate if the tooth is missing due to a non-biting accident. If this is the case, the carrier may instruct you to submit the claim to the patient’s medical plan, auto insurance policy, or Worker’s Comp.

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