Coding surgical extractions and impactions to ensure reimbursement can be a source of confusion. ADA descriptors for these codes are not always entirely clear. So, what evidence do we look for at Delta Dental of Virginia?
Surgical Removal of erupted tooth (D7210) – requires cutting of gingiva and bone, removal of bone and/or tooth, and closure. Delta Dental also looks to see if the tooth is erupted, but the position and/or the root structure interferes with removal.
Removal of impacted tooth – Soft tissue (D7220) – in this case, the tooth is not fully erupted, but can be removed without excision of bone. The tooth should be under the level of occlusion and may also include evidence of vertical angulation.
Removal of impacted teeth – Partially Bony (D7230) – the tooth is not fully under bone, but bone is interfering with the extraction requiring removal of at least some bone, and/or the bone level on the tooth prevents an adequate purchase without removal of bone. As with soft tissue impactions, tooth position and angulation are additional considerations.
Removal of impacted tooth – Completely Bony (D7240) – this is for those teeth where the bone, for example the ramus, is covering all surfaces, including the occlusal. At least a portion of all surfaces need to be involved to be considered a full bony impaction.
Removal of impacted tooth – Completely Bony with Unusual Surgical Complications (D7241) – examples of this might include access which complicates removal, involvement with the roots of the second molar and/or the inferior alveolar nerve, a tooth which is severely out of position, or in the case of a maxillary tooth, one that involves the sinus.
It goes without saying that third molars do not automatically qualify as surgical extractions and must meet criteria for the surgical extraction or impaction code being submitted. Providing complete information will help to ensure reimbursement. This includes X-rays that are of diagnostic quality, which will help avoid the possibility that the procedure will be benefited at a lesser level.
To avoid denials or an alternative benefit for a surgical extraction or impaction, it is important to be aware of the criteria before submitting a claim. If you do get a denial and wish to appeal the decision, be sure to provide additional detail in the form of radiographs, photos and/or a narrative.
Michael D Weitzner, DMD, MS
Dental Director, Delta Dental of Virginia
