When is D7220 used?
The D7220 dental code applies to extracting an impacted tooth that is partially covered by bone tissue. This classification indicates that a portion of the tooth remains beneath bone structure, necessitating surgical procedures for proper removal. Dental professionals should apply D7220 when clinical examination and X-ray imaging demonstrate that extraction cannot be completed without bone cutting and/or tooth division. While this code frequently applies to third molars (wisdom teeth), it can be utilized for any tooth that meets these specific criteria.
D7220 Charting and Clinical Use
Proper record-keeping is crucial for appropriate payment and regulatory compliance. When submitting claims for D7220, the patient record must contain:
Comprehensive clinical documentation describing the impaction details (including partial bone coverage, patient symptoms, and examination results)
X-ray images (including panoramic or periapical films) that clearly demonstrate the impacted tooth and surrounding bone structure
Surgical records detailing the treatment approach and any procedural challenges encountered
Common applications for D7220 involve partially visible wisdom teeth creating discomfort, infection, or orthodontic issues, where bone tissue removal becomes necessary. For teeth entirely encased in bone, practitioners should consider D7240 for complete bony impactions. For gum tissue impactions, reference D7210.
Billing and Insurance Considerations
To improve claim approval rates and reduce rejections, implement these recommended practices:
Check coverage details: Validate the patient's oral surgery benefits and any treatment frequency restrictions prior to the procedure.
Provide thorough documentation: Include clinical records and X-ray images with the claim submission. Most insurance companies require visual evidence of bone involvement for D7220 approval.
Create detailed explanations: Develop clear narratives explaining the appropriateness of D7220, including impaction severity and surgical requirements.
Monitor claim responses: Review Explanation of Benefits statements and outstanding balances to promptly identify and address rejected or underpaid claims.
File appeals when needed: For denied claims, examine the insurance company's reasoning, provide supplementary documentation, and submit appeals within required timeframes.
How dental practices use D7220
Scenario: A 19-year-old patient reports pain and swelling near a partially visible lower third molar. X-ray examination shows the tooth has partial bone coverage with signs of gum inflammation. The dental surgeon decides surgical removal is necessary, requiring bone tissue removal and tooth sectioning.
Processing steps:
Record clinical observations and include X-rays demonstrating the partial bony impaction.
Process the claim using D7220, with supporting narrative: "Surgical removal of partially bony impacted tooth #32 due to patient discomfort and infection. Procedure involved bone tissue removal and tooth sectioning."
Monitor claim progress and address any insurance requests for supplementary information promptly.
This methodology ensures proper coding practices, validates treatment necessity, and facilitates efficient payment processing for surgical extractions billed under D7220.
Common Questions
What causes D7220 claims to be denied by insurance companies?
D7220 claim denials typically occur due to inadequate documentation, including missing X-rays or incomplete clinical records, incorrect CDT code selection for the specific impaction type, or insufficient evidence demonstrating medical necessity for surgical extraction. Insurance providers may also reject claims when patient benefits exclude surgical extractions or when treatment frequency limits have been surpassed.
How can dental offices improve the approval rate for D7220 claims?
Dental offices can enhance approval rates by confirming patient coverage prior to treatment, submitting comprehensive documentation including clinical records, X-rays, and detailed treatment narratives with initial claims, and providing timely responses to insurer requests for supplementary information. Implementing documentation checklists and standardized forms helps minimize errors and missing information.
Does D7220 require pre-authorization and what's the proper procedure?
Certain insurance policies mandate pre-authorization for surgical extractions coded as D7220. Practices must contact the patient's insurance carrier before treatment to verify pre-authorization requirements. When necessary, submit comprehensive supporting materials including clinical assessments and radiographic images to the insurer for evaluation and approval prior to performing the extraction procedure.