Code Tip: D2980 Crown Repair

D2980 is a “crown” repair to a prosthetic not a filling in a natural tooth surface.  It is to repair a material failure as in fracture.  It would be any part of the crown.  

If a filling is needed to repair decay below the crown’s margins, report the appropriate amalgam or composite code including a narrative such as example:  “below the margin of the crown in the area of facial decay”.

A crown repair is subject to plan provision frequency limitation(5 to 10 years) as is a permanent  filling restoration on the tooth(2 years or more).

If the tooth is to be part of a fixed bridge (say abutment on #29) in the near future it may be denied for #29 abutment coverage or reduced in coverage if the filling is covered based on the plan provision. ( If #29 gets a  filling it is considered a permanent restoration.)  This could result in the denial of this tooth as an abutment to a bridge because it has been restored.

Using a Palliative code is wrong because a palliative visit is not for definitive treatment such as a filling and involves addressing pain relief only. This code cannot be combined with any treatment code on the same date.

Question is:  “Did they remove the crown, place a filling and recement?  How extensive was the decay? Did they do a build-up(cannot bill for that with the crown repair code)or did they do a filling?

They bill for what they do and explain the plan limitations to the patient.  Treatment plan in writing.

There are other codes to consider depending on the clinical notes such as D2940-Protective Restoration(with a narrative explaining the time it takes to do it, the reason and the expected time for the placement of the permanent restorative(fixed bridge).

eAssist Helpful News and Billing Tips; Edition #118