When is a Core Buildup necessary? By: Tom Limoli, Jr

The code used for core buildup-D2950, is often very confusing to dentists, especially when related to reimbursement. A core buildup is frequently called a "crown buildup" by the reimbursement industry, even though terminology was changed from "crown buildup" to "core buildup" in the 1991 CDT? Its clinical definition is quite clear since it essentially is a constructed foun- dation upon which a crown is to be seated.

A core buildup is necessary only when the tooth being crowned is so damaged that there is insufficient sound tooth structure remaining to support a restorative crown. According to some reimbursement contracts, liability acceptance for core buildups must clinically involve the remaining compromised clinical crown, which would generally be 3 mm or less in height circumferentially. From the standpoint of the dynamics of occlusion, adequate mechanical retention is required to withstand the displacement of the fabricated crown.

A core crown buildup would be necessary to furnish required retention form or resistance form. Any procedure involving tooth structure replacement for purposes of pulpal insulation, undercut elim-ination, casting bulk reduction, or for any purpose other than obtaining adequate retention would not qualify as a buildup.

However, it seems prudent to supplement the core retention provided by an endodontic post if more than 50% of the coronal tooth structure has been lost. The core buildup reimbursement criterion is an ongoing controversy. Remaining clinical structures of 3 mm or less circumferentially do not correspond to less than 50% of remaining, sound, natural tooth structure.

Forty years ago, retentive pins were extremely popular. Pins were cemented, screwed or held by a friction lock. Today, dentists have reduced their use of retentive pins because of the increased strength of dentin and enamel bonding agents, not to mention the revived use of retentive slots, "potholes" grooves and channels in tooth structure. However, there are still cases that can benefit from the use of retentive pins. A core buildup may or may not contain pins. If pins are associated with the core buildup, they are all–inclusive in the buildup procedure. The pins that are used should not be identified separately. Your fee for a core buildup should be the same whether or not pins are used.

Many reimbursement contracts consider core buildups on vital teeth to be no more than cement bases. Traditionally, payers do not reimburse providers for cavity liners or cement bases. It is most beneficial to submit code D2950 with a narrative report to avoid reimbursement confusion. The narrative for code D2950 should indicate whether the tooth is vital.

In most cases, core buildups are an allowed benefit if the radiographic and photographic evidences substantiate treatment need and if the procedure is not specifically excluded from coverage. Claims for buildups that are not submitted with the crown's insertion date are either denied, pending submission of the crown, or are reviewed by a dental consultant for liability evaluation. Claims examiners routinely deny benefits for core buildups because the claims are not submitted with x–rays, photos, or narratives. Most third–party payers agree that the burden of proof for a buildup procedure lies with the submitting dental office. It is a sad fact that most payers find core buildups being billed simply to increase the benefit payable for the crown.

A sample narrative may be: "Provides needed resistance, retention and geometric form to compromised coronal aspect of tooth. See enclosed photograph.

If you would like to be kept up-to-date each month with information on reimbursement of dental benefits and assistance in understanding patient's health-care benefits, Tom has a monthly newsletter available. Along with your subscription to the newsletter, Dental Insurance Today, you will also receive an annual comprehensive fee schedule review of 156 of the most often reported CDT procedures. Call (800) 344-2633 for subscription information.

Tom has volunteered to answer any insurance claim questions for our readers. If you have a question, please fax it to the DentalTown offices at: 480-598-3450 or you can email it directly to the Editor at: carol@dentaltown.com.

Tom M. Limoli, Jr, received his Bachelor of Science in Criminal Justice from Valdosta State University. He has actively investigated fraud-ulent claims for the insurance ind-ustry as well as numerous other third party fiduciaries. He is a licensed private investigator and has presented courses on dental insurance at the ADA and numerous dental trade and state association meetings. Tom, along with his father, Tom M. Limoli, DDS, and David Reznik, DDS have provided reimbursement consulting to the dental industry for over a quarter century. You can contact their Atlanta Dental Consultants office by calling (800) 344-2633 or visiting their website at www.limoli.com.