What is the difference between a radiographic index and a surgical implant index? How is D6190 different from D5982 and D5988?

A radiographic index (D6190) is usually made of radiopaque and radiolucent materials. The radiopaque material provides a radiographic indication of ideal implant position in relation to critical anatomic structures, and the radiolucent material temporarily fixates, or indexes, the radiopaque material to the associated hard or soft tissue structures. The index is worn by the patient during radiographic exposure.

This index can be designed in such a manner that it can also be used during implant installation to guide osteotomy creation and fixture position. In this case, it is also a surgical index. A surgical index that is not also a radiographic index does not necessarily have a radiopaque component but does have components that indicate ideal osteotomy or fixture position. The surgical index is used during osteotomy creation. Based on clinical judgment, determination of fixture position and installation may require either a radiographic or surgical index, neither, or both.

D5982 and D5988 are often billed in error. D5982, surgical stent, is utilized to apply pressure to soft tissues to facilitate healing and prevent cicatrization or collapse. D5988, surgical splint, is designed to utilize existing teeth and/or alveolar processes as points of anchorage to assist in stabilization and immobilization of broken bones during healing. Neither code is appropriate for an implant guide.

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