When is D7820 used?
The D7820 dental code applies to closed reduction of dislocation procedures in dentistry. This CDT code is utilized when patients have a dislocated temporomandibular joint (TMJ) or other facial joint, and the dental provider manually repositions the joint to its proper alignment without surgery. This code is only suitable for non-surgical procedures where no incisions or open surgical methods are employed. Typical situations include sudden TMJ dislocations caused by injury, wide yawning, or excessive jaw opening during dental treatment.
D7820 Charting and Clinical Use
Proper documentation is essential when submitting claims for D7820. Clinical records must clearly outline the dislocation incident, patient symptoms (including pain, jaw locking, or facial asymmetry), and the reduction procedure performed. Documentation should contain:
Time and date of the occurrence
How the dislocation happened
Clinical examination findings (such as locked jaw position, joint displacement)
Method used for closed reduction
Patient outcome and joint stability after treatment
Additional supporting materials like before-and-after X-rays or clinical photographs can enhance the claim and demonstrate treatment necessity. When sedation or local anesthesia is administered, proper documentation and coding of these services is also required.
Billing and Insurance Considerations
For D7820 billing, dental practices should implement these strategies to improve payment success and reduce claim rejections:
Check coverage: Prior to treatment, verify patient benefits for TMJ procedures under both dental and medical plans. Some insurers may need prior approval or only provide coverage through medical benefits.
Provide complete claims: Include thorough clinical documentation, imaging studies, and supporting materials with submissions. Clearly demonstrate the medical necessity for closed reduction and document any complications.
Apply proper codes: When sedation or anesthesia is administered, add the relevant CDT codes for these services. For surgical (open) reduction procedures, use the appropriate open reduction code instead.
Handle claim denials: When claims are rejected, examine the Explanation of Benefits for denial reasons and file comprehensive appeals with additional supporting evidence when appropriate. Emphasize the urgent nature and medical necessity of the treatment.
Consistent and precise Accounts Receivable management is crucial for ensuring claims are processed and reimbursed promptly.
How dental practices use D7820
Case: A 35-year-old individual visits the dental practice complaining of jaw pain and inability to close their mouth after yawning widely. Clinical examination shows TMJ anterior dislocation. The dentist successfully performs closed reduction, restoring normal jaw movement. Complete clinical documentation includes the incident details, examination results, reduction method, and treatment outcome. Before-and-after clinical photographs are maintained in the patient file. The insurance claim using D7820 is filed with complete supporting documentation and receives full reimbursement from the insurance company.
This case demonstrates the significance of complete record-keeping, accurate code usage, and effective insurance coordination when billing D7820.
Common Questions
Can D7820 be billed with other dental procedure codes?
D7820 can be billed with other dental procedure codes when additional services are performed during the same appointment. For instance, if a limited oral evaluation (D0140) or diagnostic radiographs are taken along with the closed reduction procedure, these should be coded separately with proper documentation. Always verify that each service is medically necessary and thoroughly documented to prevent claim denials related to unbundling or duplicate billing issues.
Do most insurance plans require preauthorization for D7820?
Preauthorization requirements for D7820 differ depending on the insurance carrier and specific plan coverage. Many dental and medical insurance plans may require prior authorization for TMJ-related procedures, particularly when the treatment is deemed medically necessary rather than purely dental. It's advisable to contact the patient's insurance provider prior to treatment to confirm preauthorization requirements and prevent potential reimbursement delays.
What causes claim denials when billing D7820?
Frequent causes of claim denials for D7820 include inadequate documentation, failure to establish medical necessity, submitting claims to the incorrect insurance type (dental versus medical), and using improper or incomplete coding. To minimize denial risk, ensure comprehensive clinical notes are included, provide diagnostic imaging, and include a detailed narrative explaining why the procedure is necessary. Also, confirm coverage details and submit claims to the correct insurance carrier.