Coding Tip: D2950 Core Build-up Debunked
This code is overused and misused in many situations. To understand it’s true application read the definitions from Coding with Confidence by Charles Blair, DDS http://drcharlesblair.com/
According to Dr. Blair “A core build-up(no longer called crown build-up) must be necessary for crown retention to be considered a build-up. The core build-up should rebuild the internal anatomy of the tooth structure as prepared for a crown. Many payers will not cover a build-up unless there is a crown being placed or will not pay for the build-up without the seat date of the crown provided. Often a core-build-up is reimbursed for a crown placed after endodontic seal because it is common for severe loss of tooth structure from decay.
Dental Billing Tips and News for Pros; Edition #131
Jillian P
Great info for when the office team is unsure about billing a core build up!
J Rodely
My experience is that insurance companies consider the “build-up to be part of the overall crown prep procedure” therefore not allowing any additional benefit for the build-up code. Any suggestions when this is the case?
Jaycee Brown
Hi J Rodely, some of our eAssisters have answers for you!
“By definition, the core buildup is a separate procedure from the crown and should always be paid as long as there’s evidence for necessity.” -Estela
“You mostly see those denials when the build and prep are submitted same day. Many times if you contact the insurance and let them know the seat date was actually later on and give them the date they will reprocess the buildup because both procedures did not actually take place the same day.” – Stefanie
“A core buildup, as long as it was necessary, will in most cases be covered by insurances with no issues at all. I always include a narrative and state that the buildup was done separate from the crown preparation because (stat reason- for example “there was insufficient tooth structure once decay and old broken restoration was removed”) and always add to that narrative that the “buildup was needed for retention of crown”, along with the crown prep date and crown seat date.” – Cheri
“When you present the treatment and need for treatment, you should clarify when the prep was complete and the delivery was complete this allows for the separate benefit for D2950.” – Jackie
Hope this helps!
Kari
Normally the D2740- crown prep needs to be performed on a separate day of service than the build up.
Michelle Cousins
We just learned that we can’t bill the buildup and crown on the same day. Anyone else having this issue?
Amy Shreves
What do you do if the patient does not have the money for the crown right now or they say they will be back for the crown but never come back. If they want he seat date, it never happened?
Amy Shreves
We have been having issues with some of the insurance companies if we do the build-up and the patient is planning on returning in the future for the crown. As we all know, not everyone does as they say and the patient doesn’t return for the crown for a year or two. I had the insurance company say they will pay once the crown is completed. I know with some insurances like MetLife, if I send in a pre-d they will cover it but UHC has been giving me issues lately.