Dramatical Cu Co i Ii rors

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Re,·m . rsement

Local anesthesia is usually considered to IDe part of Oral and Ma)(!iJlofacial SUliglcal prucedures •

.For dental benefit reporting li!urposes a quadrant is defifTecl as four 'Or mare contiguous teeth and/arte,eth spaces. distal to the midline.

R'emoval of soft nssuereteneo coronal remnants,

yO D/ltQ It Is a common coding error to report extraction, coronal remnants- decicuous tooth (07111). fm"rouDI1e"

(') WAJCH .2 deciduous (baby) tooth extractions. If pnrnary deciduous LQQ.! structures remain (wi'th the tooth)., report

0-1> AO' the 'reutme" ~xtractlon (D7140) fora primary tooth. See D7140for further details.

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cow. H1fSI 1. Report 9)(tradion, coronal rernnants-decldueus tooth (07111), for primary tooth for soft-tissue retained LIMITATIONS QQ!:Qru!! remnants, witDQut rpots, ready to exfoliate. Only the crown fragment or crown remnant is soft tissu e-:retain ed,

2 .. "Routine" pnrnary tooth extractions with any root structure present should be reported as 07140, however.

3. Fee reimbursement for :07111 is typically reimbursed as baSIC at 80% of the UCR fee.

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TIP Extraction,. coronal remnants - dsccuous tooth (D7111) could be used to report, essentially, a child's emergency visit. The primary tooth remnant is "hanging" . The fee for coronal: remnant extraction (D7111 ) essentially represents an "office VISIt" to remove the remnant, consult with the parent, and cover office overhead.

2. Another scenano would be ex.tracting several primary antenorcentrals;1aterals on the same service date where some are classified as D7111 and others as Dn 40.. If you choose to "discount" the fee m these situations, feRmi aU the extractions .. each at a discounted fee. Do not charge the 'full fee for a lower number of actual extr.actions than Were performed. M.ways report "What you do." This willi also IilrDvide better, ans proper, Jreimbursement for the pqtient

3. Some payors have an exduslolil for reimbursement of D7111 If an extraction is, J;}el'formed In conjunction with othersuTgery at the same site. For instance, when a d.eclduQus t@oth! and underlying permanent bicUSP1Gi are extracted on the same service date, some. payms weuld reimburse on'ly the underlying permanent b1cuspld tooth.

Includes routine removal 'Of tooth stw&:ture, minor smootl1ingofsoc:ketlDone •. and cloSure"as necessary.

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1. It IS a common coding error to repert exb:actt:on" coronal remnants - deotduous tooth '(07111) for 'Y[Qulme,'! decidaous :(baby) taothext:ractions. If pnmary (deC'lduous.)'fQQl.strur;:lures. remaIn, ,epo~t D 7140. See 07111 for further d'el(lilsregartllAg soft·tlssue retained coronal remnants.

2'. D7140 also reports "exposed roor removal, where the coronet portIon oi the tooth has ,~Iready br>Qken or decayed off. TIus liS completely djfferent from 07250, whiCh is a surgical procedure. See lhe surgical

removal of residual tooth roots. (D7250) for important details. .

3. Ilf ,a flap tS "Iatd" and bone jlS removed and/or the teoth sectioned, see surgIcal removal of erupted tooth (1:)7210). mere complicated and relmlbursed at the: .hlgher UCR fee,

4. '~galfls nothing to report a lower exu:actioncQunt than actua'fly performecll in order to held down the

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patient's global fee. To keep the total' extraction fee at the desired fee level, simply report a lesser fee tor ~ tG)ot~ &~tracted. Report the actual fees charged on the cia m form, if less than the regular fee. For patien~s with Insurance there may be an advantage if the contract has low UCR fees and thiS is correct

reporting. '

5. If the extraction is for orthodontics, the ADA claim form Question, "ls this for orthodontics?" must be answered "yes". If orthodontic benefits are available, then orthodontic extractions are generally reimbur.sed at 50%, subject to the typical $1,500 lifetime orthodontic benefit. However, sometimes the orthodontic extra~ti?n ~s reimbur~ed out of the general dental benefits, typically at 80% UCR (a deductible may apply); plan limitations are highly varrable ..

~~~~~~~t 1. Fee reimbursement for an erupted tooth extraction (D7140) is generally consrdered basic at 80% of UCR.

2. D7140 applies to the "routIne" extraction (single or multiple extractions) of an erupted tooth (both primary and permanent) or exposed roots. Since trns code reports "multiple extractions" on the same service date, the D7140 code would also be reported for each additional tooth extraction. Some dentists charge less for a primary tooth or "easy" extraction, even though payers typically reimburse the same UCR tee for primary or permanent teeth

3. For surgical removal of an erupted tooth, requiring elevation of mucoperiosteal flap .and removal of bone and/or section of t!Qoth, see 07210.

4. Suture removal, minor smoothmg of socket bone, closure, and follow up IS included in the global fee for an erupted tooth extraction. Routine follow up is included in the global extraction fee. Extensive Infection after third molar removal could be separately reportable, See treatment of complications (post surglCaJ) - unusual circumstances (D9930)' The description of this code describes this code to report treatment of a dry socket or removal of a bony sequestrum.

Most payers consider alveoloplasty in conjunction with extractions to be inteqtal m the global fee. However, if significant socket recontounng IS required for multiple adjacent teeth, see the commentary under D7310/D7311.

riP' 1. Some doctors, for multIple extractions, will charge for fewer extractions than were actually performed,

when some extractions may have been "easy," and they wantto give the patient a fee "break". However, this approach is wrong. 8~ reducing the true extraction count ans charging the full fee for the lesser extraction count, the reimbursement will be ~ when participating in a low UCR. plan. For better reimbursement, lower the fee that is appropriate for each extraction, rather than cut the extraction count. The total fee charged is the same with either approach. but if the patient has a low UCR plan, then .lowering the fee on 00 extraction will result in better fee reimbursement. Always resort the exact number of teeth extraeted and the actual' fee charged for each.

2. Do not report surgical removal of residual tooth mats (D7250) for the routine extracnon of exposed roots, since prosthetic replacement may be denied. Exposed roots (D7140) reman after the crown decays off. There IS a huge difference between the surgical removal of residual versus exposed roots, See D7250 for comments regarding surgical removal of res;dualtooth roots.

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Includes cutting of gingiva and bone, removal of tooth structure, minor smoothing of socket bone an~ closure.

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1. When an erupted tooth is extracted and rulli a suture placed, it is misleading to report surgical removal of an erupted tooth whtch requires elevation of mucoperiosteal flap and removal of bone and/or section of tooth (07210). If there is not a mucopenosteal "flap" and removal of bone and/or section tooth, it is!lQ1 D7210. A "suture" does not qualify in any respect as a surgical extraction of an erupted tooth (D7210). A mucoperiosteal flap and the removal of bone and/or "section of tooth" are required to report 07210.

Sectioning the tooth is enough.

2. Do not over utilize D7210 by uup coding" routine extractions as surgical extractions for higher reimbursement. This is definitely an office audit issue.

1. If an ~ •. ,. [l' .

, ooth removal requires laying a flap and removal of bone and/or section of tooth, then report . ,'140. D7210 provides a 1500/0-180% higher reimbursement fee than D7140, due to ,d dlfficutty of the procedure. With the need to maintain bone for implant placement, \ n utlizatron percentage will Increase in the future, Many general practitioner's are not . r acnon code In legitimate situations, but should. Keep in mind that the procedure ~. generally a fractiQn of the "routine" extraction (07140) counts,

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2. Su1uI . ,I' srn othing of socket bone, closure, and follow up is included in the global surgical

fee fOl' D1210. r ounne follow-up is included in the global surgical fee. Extensive infection after tooth removal, however, could be separately reportable. See 09930. Aveoloolasty in conjunction with extraction IS generally considered integral on the same service date by pay~rs. However, if multiple extractions are Involved or if Significant socket recontouring IS required, see the commentary under 07310/07311.

TIP/ 1. D7210 should oat be over-ufilized. Accurately describe the procedure, and make chrncal notes with

"elevated flap and removed bone and/or section of tooth" for removal noted. An Intraoral camera photo of the sectioned tooth can be retained for documentation. This Will prevent bemg caeght in an audit, after the fact, with Inadequate documentation.

2. Since 07210 IS a surgical extraction, some pavers require med cal submission first, before consideration of dental reimbursement. If required, attach the medical claim form (explanation of benefits) report to the dental claim form.

3. Under the 07210 descriptor, it appears that "section of tooth" Qoly IS adequate to report thrs procedure.

However, some payers may reqUire raying a concurrent mucoperiosteal flap for reimbursement.

0cCIusai surface of tooth covered by soft tissue; requires rnucoperiesteal Hap elevation.

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1. Suture removal and follow up is included in the global surgIcal fee for removal of an rnpacted tooth - soft tissue (07.220). Extensive infection after an impacted toofh remeval, however, could be separatel~ reportable. See 09930.

2 R~lmburoSement of D7220 is typically based on the payor's assessment of the narratree and the anatomical positron trom submitted diagnostic films, not the surgical technique necessary for rerneval, Ttns code requires a mucoperiosteal flap elevation, when the occlusal surface of the tooth IS covered by soft tls.sue, net bone.

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TIP 1. Sectioning the tooth is nota reqoirement tor this code, but does require mucoperiosteal flap elevation.

2, Some pa¥ors require medical, submission first, before consideration of dent~J relmburserrrsnt If required, attach the medicaJ claim term (exolanaton of benefits) to the subsequent dental claim form.

Part of Crown covered by bone; requires mucopermstealflap elevation and bone removal.

COMMENTSI 1. LIMITATIONS

D 7230 reports removal of impacted tooth - partially bony where "part of the crown is covered by bone. "Part or the crown covered by bone signifies less than 50%, according to the ptev;ousfypublishedADA CDT-4 manual's Q&A, as descnbed on page 94. However, reimbursement of D7230 is typically based on the payor's assessment of the narrative and the anatomical position from submitted diagnostic films, not the surgical technique necessary for removal. This code requires mucoperiosteal flap elevation and bone removal.

2 .. Suture removal and follow up is included in the global fee for 07.230 .. Extensive Infection after impacted tooth removal, however, could be separately reportable. See 09930.

TIP 1. In some cases 07240 may be subject to age exclusions such as reimbursement only for petents aged

fifteen to thirty.

2. Some pavers require medical submission first, Q.efQre consideration of dental reimbursement, If required, attach the medical claim form (explanation of benefits) to the subsequent dental claim form.

Most or all of crown covered by bone; requires mucoperiosteal fiap elevation and bone remo ~I

COMMENTS! 1. 07240 reports removal of impacted tooth - completely bony where "most Q[ all" of the crt

LIMITATIONS by bone. "Mosr is defined as more than 50% of the crown is covered by bone, accordmg to tht-Fe.' . ~ published ADA CDT-4 manual's Q&A, as described on page 94. However, reimbursement of 07240 IS typically based on the payor's assessment of the narrabve and the anatomical posmon from submitted diagnostic films, not the surgical technique necessary for removal.

2. Suture removal and follow up is included in the global fee for D7240. Extensive intecnon alter imfi1acted tooth removal, however, could be separately reportable. See D9930.

TIP 1. In some cases D7240 may be subject to age exclusions such as reimbursement only for patients aged

fifteen to thirty,

2. Some pavers require mediCal submission first, ~. consideration @'f dental reImbUrsement If reql:llred, attach the medical claim form (explanation of benefits) report to the subsequent dental claim.

Most or an of crown covered by bone" unusually difficult or complicated due to factors such as nerve cissecnon required,. separate closure of maXillary smus or aberrant tooth position.

COMME.NTS/ 1. 07241 reports removal of Imp'acted tooth - completalybonY where 'most or all~ of the crown Is coveted U ITATIONS by bone. ~Mosr is defined as more than 50% of the crown IS covered In bone, according to the previously published ADA CDT4 manual's Q&A, as described on page 94. However, reimbursement of D7241 IS typically based on the payors assessment of the narrative and the anatomical position from submitted diagnostl€ films, not the surgical technique necessary for removal.

2. This code relates to removal of a completely bony impal=tion which is "unusually difficult or complicated due to factors such as Jimrve dissection required, separate closure of maxillary sinus, or aberrant tooth positIon", It carnes a higher rembursemeer than a' routine complete bony mpacton. This code would be submitted Infrequently and underexceptonal Circumstances.

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3. Suture removal and follow up ls included In the global fee for D 724.1. Extensive infection after Impacted

tooth rerneval, however. could be separately reportable. See D9930. .

TIP

1. In some cases 0'7241 may be subject to age exclusions such as reimbursement onlytor patients aged fifteen to thirty.

2. Some payers reqllite medical submission first, before consideration of dental reimbursement. If required, attach the medical claim form (explanation of benefits) to the subsequent dental claim.

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Includes cutting of soft tissue and bone, removal of tooth structure, and closure.

1. Many practices misuse the reporting of surgical removal of residual tooth roots (cutting procedure) (07250). Misreportrngthis cede for "difficult" erupted tooth extractions (chasing the root after coronal portion fractures off) can in~aHda:te reimbursement for a bridge, partJal, or "implant-type" crown. If "laying a flap" or sectioning for the difficult, erupted tooth IS necessary, report D 7 210.

2. "Rf"~ '(It 1r1!()oth roots" does not represent a cutrent extraction of a tooth according to some plan limitations.

r··. 'f ~ -ases when a previous extraction resulted in leaving a residual root embedded in the bone.

r.tie D7250 the "missing tooth" clause may be invoked and the new bridge, implant oerned. However, if the roots remain from the ~ or fracture !Q.s.s of the crown, ... moved without cutting of the soft tissue and bone, then that may be reported as an . lid roots, D714D.

ring of the soft tissue and Done, removal of tooth structure, and closure". This code IS '-'I ' J • ", enture preparation as to removing residual root fragments remaining in the bone, often from d ~rt.; 10US (years earlier)' extraction. Some payers require a diagnostic film to confirm that the reSIdual root IS completely embedded in bone.

2. D7250 would be reported by an oral surgeon when a general practitioner attempts the extraction of a touth and cannot remove the roots, and refers the pabent for completIon of the procedure (removal of the resdual tooth roots),

3. Suture removal and follow up is Included in the global fee for D7250. Extensive infection after third molar removal, however, would be separately reportable, See D9930.

TlP 1. Reporting 07250 can Invalidate replacement with a bridge, implant, or partial denture, since some plans

require an extracuon of a tooth (in occlusion and more than 25% of the crown remamng) dun~g. the associated contract penod. Thus use of D7250 may mvoke the ilmlssil,'lg tooth" limitation.

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2. Some payers require medical submission first, b.efQm conslderatlen of dentalreimbursemerit since this is a surgical dental code. If required, attach medical clam form (explanation of benefits) to subsequent dental claim.

Subsequent to surgical removal of tooth, exposure of snus requIting repair, or Immediate closure of I omantral or oralnasal communication in aDsenae of nstulus tract.

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COMMENTSj l.
LIMITATIONS
2.
TIP 1. 07270 reports reimplanting and/or stabilization of an accidentally evulsed or displaced tooth. In some cases, the tooth (teeth) is (are) stabilized with a bonded wire to anchor teeth (splinted).

Any adjustments, removal of splint, or follow up visits,are included in the initial global fee, so charge accordingly.

If the alveolus is fractured. see 0767Q.

Do not report 07998 in addition to this code. It would be considered integral.

For splinting/stabilizing of mobile (periodontally involved) teeth, see D4320 and 04321.

07270 may also be reimbursed under medical or accident insurance. Most payers consider medical insurance for accldent and trauma as primary for reimbursement purposes. The ADA claim form should reflect any other Insurance, if applicable.

2. Some payers require medical submission first, ~ consideration of dental reimbursement If required, attach medical claim form (explanation of benefits) to subsequent dental claim. Some dental payors have a 6-12 month filing limitation. Go ahead and file a dental claim (with all pertinent Information) to avoid tillS hmitation, if medical is slow and the limitation period IS close.

1, It is a common coding error to report a tooth transplantation (D7272) as a tooth relmpl'antatlc If· an accident; D7272 is D.Qt accident-related. See 07270 or 07670 for further details.

2. Another error is to report D7272 as an intentional reimplantat on (D3470), which IS an endodontc-related procedure. See 03470 for further details.

3. Do not report D7998 in addition to this code.

COMMENTS; 1. Tooth transplantation (07272) is for transplanting (extracting and moving) a tooth from one site to another.

llMJTATIONS For instance, transplanting a third molar to a second molar socket. This i.~ llirt a ~ommQn orocedure.

2. However, tooth transplantation is not generally reimbursed. If tooth transplantationis reimbursed, the associated extraction may be considered in the global fee for 07272.

An incision is made and the tissue is reflected and bone removed as necessary to expose the crown of an impacted tooth not intended to be extracted,

Surgical access of alj unerupted tooth (D7280) is often orthodontically-related. The ADA claim form has a question,~ls this for orthodontics?" Most software programs, by default, answer this "no". It is misleading to answer uno", if true. Reimbursement for D7280 may come out of the "lIfetime orthocontc benefit" (typic'ally $1,500) if available, or alternatively, possibly out of the general dental benefits.

For plaCing the attachment (button, pin, band or, bracket), If applicable, which is a separate, but associated procedure, see D7283 for further details.

1. 07280 IS often reported In assooation With "uncovering" an unerupted/impacted tooth for an orthodontic "button," band., pin or bracket to beglaced.

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~. 1"\ lJearCle or free soft tissue graft may also be re

for further details. quired as a separate procedure; se:€ 1)4270 and 04271

TIP

D7280 will probably reqUIre an ort!lodontic rider f r burs . - - . - .

arthodontlcs?~ must be answered ')es". - - 0 rern ursement. The claim form question, "ls this for

TIP

,~rtID~ """,;) =." :::l!:>l1iq reporting.

~ 07281 was deleted under CDT- 2005. See 07280 10r current

r ,""en! of an orthodontic bracket, band or other device on an unerupted tooth, after its exposure, to aid I _ ..... 1011. Report the surgical exposure separately using 07280.

t of devce to facilitate eruption of impacted tooth (07283) is orthodontically-related. The ADA 'i las a cuesuon, "is this for orthodontics?" Most software programs, by default, answer trus ,';;, nusleadmg to answer "no", if it is an orthodontic-related procedure. Reimbursement far '. '1 orne out of the "lifetime orthodontic benefit" (typically S1 ,500), If available, at 50% UCRt or i o t of the general dental benefits,

I cement of device to facilitate eruption of Impacted tooth (07283) reports plaCing a "button,· bracket, ectopic pin, or band on an unerupted tooth, after exposure of the crown. This code is associated with surgical access of an unerupted tooth (07280).

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07283 may be eligible for reimbursement tt surgical access of an unerupted tooth (07280) procedure IS also reimbursed. See D7280.

np 07283 will probably require an orthodontic nder for reimbursement. The claim form question. Ills thiS 'for orthodontICs?" must be answered "yes".

For r movalo1 specimen only. This code IllvolVes biopSY ot osseoustesons and IS not used for apicoectomy/ penradlCular surgery.

BIOpsy of oral nssue ... hard {bone. tooth.) tD7285) IS for rep.ortmg a biOpsy of osseous lesons, A biOpsy IS remo ng nssue for histologIC e'_ uenon, _ est general erac oners 'Outd!lOt generally perform thiS

procedure.

out an accompanYing

2. BIopSIes may be consIdered: to be Integral assoca ed procedures performed m the same are~, on

the same servce date. D7285 IS not to be reported Itl-conunct on ~. aPIcoectomy or penradlcular

surgery.

3. For medical reimbursement, a "referral'" may be reqUired from either the pattenrs pnmary care phYSICian .or the patien~s medicallnsurante carner. Advtse the patient accordmgly.

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TIP .Remit the hard tissue biopsy specrnentor analysi.s and wait for pathology results m:wr to submitting a claIm. Once the pathology report is receIVed; make a copy,and obliterate the diagnosIs (for HIPAA purposes). Report D72:85, attaching the pathology report to a gaper dental daim form. Without a pathology report, the. 'hard tissue biopsy procedure will probably not be reimbuts'ed by dental, Insurance .

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for surgical removal of an architecturally intact specimen [Ioly. This code is not used at the same time as ' codesforaplcoectomy/periradicu!ar curettage ..

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A biOPSY is removing tissue for histologic evaluation. Biopsy of oral tissue - soft (D7286) is D.Q.t reported as "OraICDx® brush biopsY'. This is a common error. Report 9nl~ brush biopsy - transepitnelial sample collection (D7288)" for the OralCDx® brush biopsy.

COflllM.ENTSj I. Report D 7286 for an excislonat soft-tissue biopsy. A biopsy is removing tissue for a pathOlogy ;diagnosis.

UMITATI'ONS The specimen is architecturally intact.

2. The biopsy will not typically be reimbursed by dental ,insurance without an accompanying pathology report.

3.. A biopsy may be considered to be integr.al with associated procedures performed in the same area, on the same service date. '07286 IS not to be reported in conjunction With apicoectomy or periradi.cular curettage.

4. For medical reimbursement, sometimes a "referral" may be required from B,ither the patient's primary care phYSICian ill the patlenes medica! insurance carrier. Advise the patient accordingly ..

TIP' Remit the sott tissue biopsy specimen for analYSIS and wait for .pathol'ogy results prior to submrUrng a dental claim. Once the pathology report is received, make a copy, and obliterate the diagnosis (for HIPAA purposes). Report D7286, attaching the pathology report to. a paper dental claim form. Without a pJatho.logy report, the soft tissue biopsy proeedure will probablY not be reimbursed by dental insurance.

For collection of non-trans epithelial cytology sample via mild scraping of the oral nucosa

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Some practices erroneously report exfoliative cytological sample collection (D7287)as the "0raICDx.® brush biopsy", For the OralCDx® brush bIOPSY, report brush biopsy - transeplthelial sample collectlon (07288).

OOMMENTS/ 1 . Report 07287 for a non·transepithelial cytology sample. UMlfATIONS

2. D7287 will not typically be reimbursed without an attached pathology report to the dental claim fOrm.

3. A biopsy is for removal of the specimen only. Biopsies may be considered to be Integr.al with assocated procedures performed in the same area, on the same service date.

4. For medIcal r.eimbursement, sometimes a referral. is required from either the patienfs prmarycare , physician Q[ the patient's medica! insurance carrier. Advise the patient a:ccordingty.

TIP Remit the soft tissue biQJ:~sy speeimen for analysis and w,ait for pathology results prior to submittin.g iii dental cI.aJlll. Once the patho;logy report is received, make a copy, and obliterate the diagnOSis ,(for HIPAA pu~posest Report D7287, attachlngfhe~attlOlogy report to a DaQ~r den~a1 claim form. Without a pathology report, the soft tissue biOPSY procedure will probab.ly not be feirnbtl(sed by dental insurance.

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