When is D7620 used?
The D7620 dental code represents "Maxilla – open reduction (teeth immobilized, if present)" treatment. This CDT code applies when patients need surgical treatment to stabilize and reposition a broken maxilla (upper jaw), usually after trauma. Dental practices should apply D7620 when maxillary fractures require open reduction treatment, where the bone is surgically accessed and repositioned, with existing teeth stabilized during the process. This code does not apply to closed reduction treatments or fractures affecting only the mandible or other facial structures.
D7620 Charting and Clinical Use
Proper documentation is critical for successful D7620 claims. Clinical records must include:
Comprehensive description of the trauma causing the maxillary fracture
X-ray evidence confirming the diagnosis and treatment approach
Details of the open reduction method employed
Information on tooth immobilization procedures, when relevant
Before and after treatment evaluations
Typical clinical situations involve car accidents, athletic injuries, or falls causing complex upper jaw breaks. When additional treatments are performed—like bone grafting or soft tissue reconstruction—document and code each service individually. For instance, if mandibular fracture treatment is also needed, apply the corresponding code such as D7610 for mandibular procedures.
Billing and Insurance Considerations
Processing D7620 claims demands close attention to insurer requirements and documentation protocols. Follow these recommendations to improve reimbursement success:
Check medical versus dental coverage: Most insurers classify maxillofacial trauma under medical benefits. Confirm patient coverage and benefits prior to treatment.
Provide complete clinical records: Include X-rays, surgical reports, and detailed descriptions to demonstrate medical necessity.
Apply proper modifiers: When treating multiple facial bones, add suitable modifiers and itemize each procedure separately.
Handle denials quickly: For rejected claims, examine the Explanation of Benefits for denial reasons and file detailed appeals with supporting documentation.
Manage benefit coordination: When both dental and medical insurance apply, identify the primary carrier and file claims properly to prevent Accounts Receivable delays.
Keeping current with insurer policies and CDT code changes is essential for reducing claim denials and securing timely payment.
How dental practices use D7620
Take a patient injured in a cycling accident with a displaced maxillary fracture. The oral surgeon conducts an open reduction, accessing the fracture area, repositioning the bone, and securing the upper teeth using arch bars. The treatment is fully documented with before and after X-rays, surgical notes, and detailed explanations justifying the open reduction approach. The billing staff confirms the patient's medical insurance covers trauma procedures as primary coverage, files the claim with complete supporting materials, and monitors the insurer for timely payment. This practical example demonstrates the need for accurate coding, complete documentation, and effective insurance coordination when processing D7620 claims.
Common Questions
Can D7620 be billed together with anesthesia or other surgical procedure codes?
Yes, D7620 can typically be billed alongside anesthesia codes or additional surgical procedures performed during the same operative session, as long as each service is medically necessary and thoroughly documented. Always follow specific payer guidelines regarding service bundling and unbundling, and ensure detailed operative notes are included to justify each billed code.
Does medical insurance, dental insurance, or both cover D7620?
Coverage for D7620 may come from dental insurance, medical insurance, or both, depending on the patient's specific policy and the nature of the injury. Since maxillofacial trauma can be classified as a medical condition, it's essential to verify benefits with both insurance types prior to treatment and coordinate benefits when applicable.
What is the typical timeframe for receiving reimbursement on a D7620 claim?
Reimbursement timeframes for D7620 claims differ by insurance provider, but most dental and medical insurers typically process claims within 2 to 6 weeks when all required documentation is properly submitted. Processing delays may occur if additional information is needed or if the claim requires an appeal following denial. Complete and timely documentation helps accelerate the reimbursement process.