When is D7490 used?
The D7490 dental code applies to radical resection procedures involving the maxilla or mandible. This CDT code is utilized when dental professionals or oral surgeons need to excise substantial portions of the upper jaw (maxilla) or lower jaw (mandible), commonly due to aggressive conditions like malignant growths, extensive bacterial infections, or serious traumatic injuries. Different from standard tooth extractions or minor bone procedures, D7490 is appropriate when the treatment requires removing large bone segments, whether or not immediate reconstruction follows. Proper differentiation of D7490 from codes covering simple extractions or less complex surgical interventions is vital for accurate billing practices and regulatory compliance.
D7490 Charting and Clinical Use
Accurate documentation remains critical for successful payment processing when applying D7490. Medical records must contain:
Comprehensive diagnosis details (including tumor classification and location, infection scope, or trauma characteristics)
Pre-surgical imaging results and observations (including X-rays or CT scan findings)
Surgical report detailing the specific region and volume of bone removed
Documentation of concurrent procedures (such as reconstruction work or bone grafting)
Laboratory pathology findings when relevant
Typical clinical applications for D7490 encompass resections for oral malignancies, bone infections, or complex jaw injuries. Medical necessity must be thoroughly documented in patient files to validate the application of this specialized surgical code.
Billing and Insurance Considerations
Processing claims for D7490 demands careful attention and proactive insurer engagement. Consider these recommended approaches for optimal claim acceptance:
Prior Authorization: Submit authorization requests beforehand with comprehensive documentation, including medical records, diagnostic images, and detailed treatment protocols. Most insurance companies mandate this step for major surgical interventions.
Include Supporting Documentation: Submit surgical reports, laboratory findings, and diagnostic images alongside claims to establish medical necessity.
Apply Accurate Coding: Verify that D7490 is not mistaken for codes covering less extensive treatments, such as residual root extraction (D7250) or bone contouring procedures (D7310).
Track Progress: Review claim progress through your accounts receivable system and prepare to address information requests quickly or pursue appeals for rejected claims.
Detailed documentation combined with active insurance communication helps reduce processing delays and claim rejections for D7490 submissions.
How dental practices use D7490
Clinical Example: A 58-year-old individual arrives with a fast-growing mass in the left rear mandible area. Diagnostic imaging reveals a cancerous growth penetrating the jaw structure. Following team consultation, the oral surgeon conducts a radical mandibular resection, eliminating the tumor and affected bone tissue. The treatment receives thorough documentation, covering pre-surgical imaging, surgical observations, and resection scope. The practice files for prior authorization and subsequently bills using D7490 after approval, including all relevant documentation. The claim processes without issues, resulting in prompt payment to the practice.
This case demonstrates the value of thorough record-keeping, appropriate code application, and careful insurance management when billing for advanced surgical treatments like D7490.
Common Questions
Is D7490 considered medically necessary and how is medical necessity established?
D7490 is exclusively utilized for medically necessary procedures. Medical necessity is established through comprehensive diagnostic evidence including radiographic imaging, pathology reports, and detailed clinical documentation that demonstrates less invasive treatment options are not feasible. The procedure must address serious conditions such as aggressive tumors, extensive cystic lesions, or severe infections that threaten jaw structural integrity.
Can D7490 be submitted with other dental or medical procedure codes?
D7490 can occasionally be billed with other procedure codes when additional treatments are performed during the same surgical session, including bone grafting or reconstructive procedures. Each procedure requires separate documentation and justification. Coordination with medical billing codes may be required when the procedure qualifies for medical insurance benefits.
What causes insurance claim denials for D7490 and how can they be prevented?
Frequent denial reasons include inadequate documentation, missing preauthorization, or insufficient demonstration of medical necessity. Prevention strategies include submitting complete required documentation, securing preauthorization when mandated, and clearly articulating the radical nature and medical necessity of the procedure in claim submissions. Respond promptly to insurer information requests and appeal denials with comprehensive supporting evidence.