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Managing bleeding after tooth extractions requires specialized protocols and proper billing. Dental code D7922 provides a way to document and bill for the placement of biological dressings that control bleeding or stabilize clots in extraction sites. Dental teams need to understand when this code applies, how to document it properly, and how to navigate insurance reimbursement successfully.
Nov 1, 2025
What is Dental Code D7922?
D7922 covers the placement of an intra-socket biological dressing to aid in hemostasis or clot stabilization, per site. This procedure involves packing the extraction socket with a hemostatic agent immediately after tooth removal or during a follow-up visit to control bleeding. The code applies only when a biological material is placed specifically to manage bleeding or stabilize blood clot formation.
The code was added to the Current Dental Terminology (CDT) system in 2020 to fill a documentation gap. Before D7922, dental practices had no direct way to report the use of biological materials like collagen plugs, oxidized cellulose, or gelatin sponges placed to reduce bleeding risk. This code falls under the Oral and Maxillofacial Surgery category of service.
Common Terminology
Hemostatic agents are biological or synthetic materials designed to control bleeding by promoting blood clot formation. Common types used in dentistry include collagen plugs, oxidized cellulose, gelatin sponges, and thrombin-based products.
The following terms appear frequently in D7922 documentation:
Hemostasis: The process of stopping blood flow from a damaged vessel
Biological dressing: A material derived from natural sources or designed to mimic biological tissue, placed in the socket to aid healing
Clot stabilization: Supporting and protecting the blood clot that forms after extraction to prevent displacement or breakdown
Intra-socket: Placement within the tooth extraction site
Per site: Billed individually for each extraction socket treated with biological dressing
When is D7922 Used?
D7922 should be reported only when a biological dressing is placed specifically to control bleeding or stabilize clots. The code does not apply to routine post-extraction care or to materials placed primarily for bone grafting or guided tissue regeneration purposes.
Common Clinical Scenarios
Clinical situations where D7922 is appropriate include cases where standard gauze pressure fails to control bleeding or where patient factors increase bleeding risk. Understanding these scenarios helps dental teams identify when to use the code and how to document medical necessity.
The following situations typically warrant use of D7922:
Patients on anticoagulant therapy: Those taking warfarin, direct oral anticoagulants, aspirin, or other blood-thinning medications may experience prolonged bleeding after extractions
Bleeding disorders: Patients with hemophilia, von Willebrand disease, thrombocytopenia, or other clotting abnormalities require additional hemostatic support
Liver disease: Hepatic impairment affects production of clotting factors and increases bleeding risk
Persistent bleeding despite standard measures: Cases where gauze pressure and bite packs do not achieve hemostasis within a reasonable timeframe
Large or difficult extractions: Surgical extractions involving significant bone removal or soft tissue trauma may require biological dressings to support healing
Medically compromised patients: Those with diabetes, immunosuppression, or other conditions affecting wound healing may benefit from biological dressings
When D7922 is NOT Appropriate
Distinguishing between appropriate and inappropriate use prevents claim denials and audit issues. Several common scenarios do not meet the criteria for D7922 billing.
D7922 should not be used in these situations:
Routine post-extraction care: Standard gauze placement or simple pressure does not justify using this code
Bone grafting procedures: Materials placed primarily for ridge preservation or bone regeneration should be billed under graft codes, not D7922
Barrier membranes: Materials used for guided tissue regeneration fall under different codes such as D4266
Prophylactic use without clinical indication: Placing biological dressings as a routine practice without documented medical necessity
Materials included in other procedures: Some surgical codes already include hemostatic materials in their descriptor
Normal bleeding controlled with standard measures: Cases where gauze pressure alone achieves hemostasis
Billing and Insurance Considerations
Successful reimbursement for D7922 requires attention to documentation standards, coverage verification, and common billing errors. Dental teams should establish protocols that address each of these areas before submitting claims.
Documentation Requirements
Clear and detailed clinical notes support medical necessity and increase the likelihood of claim approval. Every D7922 submission needs specific documentation elements in the patient record.
Clinical documentation should include:
Medical history: Patient conditions or medications that increase bleeding risk, including specific anticoagulant names and dosages
Clinical indication: Why the biological dressing was necessary, such as "bleeding not controlled after 20 minutes of gauze pressure" or "patient on warfarin with INR of 2.8"
Material used: Specific product name and type of biological dressing placed, such as "oxidized cellulose plug" or "collagen hemostatic agent"
Timing: Whether placement occurred at the time of extraction or during a subsequent visit to manage persistent bleeding
Site location: Tooth number and specific socket treated
Patient response: How the site responded to the biological dressing placement
Radiographic Documentation
Radiographic documentation typically is not required for D7922 since the procedure focuses on soft tissue management rather than bone structure. However, pre-operative radiographs showing the tooth to be extracted should be in the patient record.
If complications arise or if the biological dressing is placed during a follow-up visit, post-operative radiographs may be appropriate to rule out retained root fragments or other issues contributing to bleeding.
Insurance Coverage
Insurance coverage for D7922 varies widely among carriers and plan types. Many plans consider hemostatic materials part of routine extraction care rather than a separately billable service.
Coverage considerations include:
Medical necessity requirements: Most carriers reimburse D7922 only when clinical documentation demonstrates clear medical need beyond routine care
Per-site billing: Each extraction socket treated requires separate billing, not one charge for multiple sites
Bundling policies: Some carriers bundle D7922 with extraction codes and do not provide separate payment
Plan limitations: Coverage may be restricted to specific patient populations, such as those on anticoagulants or with documented bleeding disorders
Prior authorization: Rarely required for D7922, but some high-risk cases may benefit from pre-treatment communication with the carrier
Common Billing Mistakes
Avoiding frequent errors reduces claim denials and improves reimbursement rates. Dental billing teams should review these common pitfalls regularly.
Watch for these billing errors:
Bundling with extraction codes: Billing D7922 with the extraction code when the payer does not allow separate payment
Using D7922 for bone grafts: Confusing hemostatic dressings with bone graft materials leads to incorrect code selection
Insufficient documentation: Submitting claims without detailed clinical notes explaining medical necessity
Billing without clear indication: Reporting D7922 as routine practice rather than for specific clinical need
Incorrect site counting: Billing one unit when multiple sockets were treated or billing multiple units for the same socket
Missing medication lists: Failing to document anticoagulant therapy or bleeding disorders that justify the procedure
Common Questions
How often can D7922 be billed?
D7922 is billed per extraction site, per date of service. There is no frequency limitation on how often the code can be used, as each extraction represents a separate clinical event. If a patient returns for additional extractions at a later date, D7922 can be billed again if clinically indicated for those new sites.
What is the difference between D7922 and D4266?
D7922 reports placement of biological dressings specifically for hemostasis or clot stabilization. D4266 reports guided tissue regeneration with a resorbable barrier membrane for periodontal defects. The key distinction is clinical purpose: D7922 controls bleeding while D4266 promotes bone and tissue regeneration. Both codes may be reported separately when both procedures are performed at the same site for different clinical purposes.
Can D7922 be billed with bone graft codes?
Yes, D7922 can be billed separately from bone graft codes when both procedures are performed and documented. A collagen plug may be placed to control bleeding in a large bony defect, followed by placement of a bone graft material with a barrier membrane. Each procedure serves a distinct clinical purpose and should be documented and billed separately.
Does D7922 require a separate consent form?
D7922 typically does not require separate informed consent beyond the extraction procedure consent. However, practices should discuss with patients that additional materials may be needed to control bleeding, particularly for patients on anticoagulants or with bleeding disorders. Including language about hemostatic materials in standard extraction consent forms provides appropriate disclosure.
How should D7922 be documented for patients on direct oral anticoagulants?
Documentation should specify the medication name, dosage, indication for use, and whether the patient continued or discontinued the medication before extraction. Note the patient's prescribing physician contact information and any consultation that occurred. Record the clinical response to the biological dressing, including time to hemostasis and any follow-up required.
What happens if a claim for D7922 is denied?
Review the explanation of benefits to identify the denial reason. Common denial reasons include lack of medical necessity documentation, bundling with the extraction code, or plan exclusions. Gather all supporting documentation, including clinical notes, medication lists, and any correspondence with the patient's physician. Submit a formal appeal with a detailed narrative explaining why the biological dressing was medically necessary and not part of routine care.
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