When is D3920 used?
The D3920 dental code applies to hemisection procedures, which involve surgically removing one root along with its related crown portion from a multi-rooted tooth. This procedure code specifically excludes endodontic treatment, making it appropriate only when hemisection occurs without simultaneous root canal therapy. Typical clinical situations include significant bone loss, fractured roots, or isolated infections affecting a single root of a tooth, particularly in mandibular molars. Correct application of D3920 helps ensure proper documentation and appropriate compensation for this specialized surgical intervention.
D3920 Charting and Clinical Use
Thorough documentation plays a vital role when processing claims for D3920. Clinical records must contain:
A comprehensive diagnosis that supports the hemisection decision (such as isolated periodontal disease or root fracture).
Pre-treatment radiographic images demonstrating the condition of the involved root structure.
A procedural description outlining which root and crown section were surgically removed.
Post-treatment documentation and recovery care guidelines.
Common applications for D3920 involve molars where one root cannot be restored while the remaining root structure can adequately support future restorative work or prosthetics. For example, when a patient has a vertical fracture in the distal root of a mandibular first molar, yet the mesial root remains sound, hemisection often represents the optimal treatment approach.
Billing and Insurance Considerations
Processing claims for D3920 demands careful attention to prevent rejections or processing delays. Consider these recommended practices:
Check benefit coverage: Prior to treatment, contact the patient's insurance provider to confirm hemisection (D3920) coverage and determine if prior authorization is necessary.
Provide complete documentation: Include diagnostic images and detailed clinical descriptions with your claim submission. This establishes treatment necessity and minimizes denial risk.
Apply appropriate CDT codes: Avoid combining D3920 with endodontic procedure codes like anterior root canal or molar root canal. Submit separate billing for these services when performed during different visits.
Track EOBs and AR: Examine Explanation of Benefits statements for accurate processing and quickly address any rejected or underpaid claims. Keep detailed accounts receivable records for all surgical procedures.
File appeals as needed: When claims face denial, prepare appeals including supplementary documentation such as comprehensive narratives and supporting radiographic evidence to prove hemisection necessity.
How dental practices use D3920
A patient presents with a mandibular first molar showing severe bone loss surrounding the distal root caused by localized periodontal disease, while the mesial root maintains good health. The treating dentist concludes that hemisection offers the optimal solution for preserving partial tooth structure. The treatment protocol includes surgical removal of the distal root with its corresponding crown portion, then restoration of the remaining tooth elements. The practice files a claim using D3920, attaching both pre-treatment and post-treatment radiographs along with comprehensive procedural notes. The insurance company processes the claim successfully, and the patient receives effective restoration, illustrating the clinical benefits and financial advantages of precise coding and thorough documentation.
Common Questions
Which teeth are most suitable for D3920 hemisection procedures?
D3920 is primarily performed on multi-rooted teeth, especially molars, since these teeth can be surgically divided with one root removed while maintaining the remaining portion. The procedure applies to both upper jaw (maxillary) and lower jaw (mandibular) molars, depending on the specific clinical situation and treatment requirements.
Is it possible to combine D3920 billing with other dental treatments?
D3920 can indeed be billed concurrently with additional procedures like crown installations or periodontal treatments, provided that each service is properly documented and individually justified. The key is to assign correct codes for every procedure while supplying comprehensive documentation that establishes medical necessity for all services rendered.
What factors beyond inadequate documentation typically cause D3920 claim rejections?
Beyond insufficient documentation, frequent denial causes include hemisection procedures not being covered under the patient's specific dental insurance plan, failure to obtain required preauthorization when mandated by the insurer, or the insurance company's determination that tooth extraction or alternative treatments would have been more clinically appropriate. It's essential to confirm coverage benefits and review plan-specific prerequisites prior to claim submission.