Here in the US there is a billing code for provisional restorations. Do you use it? When? I looked at this question in my practice over a decade ago and developed a protocol. It isn’t foolproof, but allows me to invest the time I need to create and utilize provisionals in many cases where they are a critical component to success – not simply a temporary cover for a prepared tooth.
This is the critical differentiation for me: When the provisional is a restoration in its’ own right. When making it serves a purpose other than covering the tooth that is critical for optimal clinical success we bill the patient for it as a separate service. One distinguishing factor can also be that the provisional will likely be remade or altered prior to fabrication of the final restoration.
In my practice I often use provisional restorations to test esthetic changes. For patients where we are altering tooth position and shape, I use the provisional to allow them to see and accept these changes. We will adjust embrasure form features like incisal edge position and embrasure form and then take impressions of the final provisional for the laboratory to use as a prototype. This same process occurs when I am altering a patient’s occlusal scheme or opening vertical dimension and need to verify the patient’s comfort and function.
Another situation that comes to mind is when a tooth may need crown lengthening. I prefer to make this final recommendation because I have done a preliminary prep and evaluated the ability to place a margin above the attachment, get an adequate impression and remove all decay, cracks etc. I then place a provisional and send the patient to the surgeon. They now have the ability to remove the provisional, gain better access and visualize the challenge they are helping to overcome so they can most effectively perform the surgery.
One of the things I know about charging a fee for these “interim” restorations is it allows me to be comfortable taking my time and doing my best work. The individual circumstances are explained to the patient and why this process will be beneficial, along with the fee.
UPDATE 12/15/11:
One of my friends, Dr. Jim Fondriest asked on Facebook “what code do you use….”, so I thought I would share my answer here:
First I’ll say we do not file any of the provisionals to insurance, as they will then exclude payment for the final restoration or place a time restriction. With this in mind a conversation with the patient is important to create understanding as to why the prescribed course of treatment has health value for them. The code we use is D2970, which is a temporary restoration for use when assessing the prognosis of a tooth prior to placing a final restoration.
To see the original discussion, you can visit my Facebook page by clicking on this shortcut:https://www.facebook.com/drleebrady?fref=nf
Hi Lee –
Code D2799 is defined as –
“Provisional Crown – Crown utilized as an interim restoration of at least six months duration during restorative treatment to allow adequate time for healing or completion of other procedures. this includes, but is not limited to changing vertical dimension, completing periodontal therapy or cracked-tooth syndrome. This is not meant to be used as a temporary crown for a routine prosthetic restoration.”
ADA 2006 Code on Dental Procedures and Nomenclature. (i’m sure there are more recent versions”
Aly
Aly,
Exactly and I use this code for these reasons as you listed them. As I said above int he update the challenge of course is how to manage this with patients who have dental insurance. Make sure you are following the guidelines if you “participate” with a plan and are clear on how benefits will be handled if you file for a “provisional”.
Can this code be used for a provisional crown that will fit over an existing abutment? (D2799)
I would think so
Lee,
Great piece. I have to say that I find the combination of these two codes inadequate for some needs. What if like you say you are assessing the esthetics over the course of 2-3 months? You aren’t really assessing the prognosis (as in a 2970) and it’s less than 6 months (as in a 2799). One of the spots that really drives me crazy though is that the 3 insurance plans I participate in dictate that when I do a core and provisional prior to crown-lengthening there is no reimbursement for the provisional. I usually work with a periodontist who employs the biologic shaping technique which often requires the provisional to be relined and ultimately the tooth to be totally reprepped. It definitely frustrates me that the insurance plans dictate that all this extra work is not worthy of reimbursement. A little venting here, but I’d love it if the codes we had made for more of a justification for these procedures.
Love the blog. Thanks for taking the time to write it!-kurt