When is D7870 used?
The D7870 dental code applies to temporomandibular joint (TMJ) arthrocentesis procedures. This treatment includes joint space irrigation with or without manipulation, commonly performed to reduce discomfort, enhance jaw mobility, and treat TMJ conditions that haven't improved with conservative approaches. Practitioners should apply D7870 for patients experiencing TMJ issues—including discomfort, restricted jaw mobility, or joint sounds—that persist despite conservative treatments like oral appliances or pharmaceutical interventions, and when examination and diagnostic images show joint fluid accumulation or structural problems.
D7870 Charting and Clinical Use
Proper record-keeping is essential for successful D7870 reimbursement. Clinical documentation should contain:
Comprehensive patient background, including unsuccessful conservative approaches
Examination findings (such as joint sensitivity, restricted opening, jaw deviation)
Imaging study results confirming TMJ pathology
Thorough procedure description, including anesthetic type, needle placement attempts, and any intra-articular medications given
Post-treatment care instructions and monitoring schedule
Typical clinical situations for D7870 encompass acute or persistent TMJ discomfort not improving with appliance treatment, possible joint adhesions, or inflammatory joint conditions. Always maintain thorough medical necessity documentation, as insurance providers frequently require supporting evidence before authorizing payment.
Billing and Insurance Considerations
Processing D7870 claims demands careful attention and strategic planning. Consider these recommendations:
Check coverage: Prior to scheduling arthrocentesis, verify patient dental and medical insurance benefits for TMJ treatments. Some policies may need prior approval or only provide coverage through medical benefits.
File complete claims: Include clinical documentation, imaging studies, and detailed explanations of medical necessity. Apply the appropriate CDT code (D7870) and correlate with relevant ICD-10 diagnostic codes for TMJ conditions.
Track EOBs and AR: Following claim submission, monitor benefit explanations and address outstanding accounts receivable quickly. For denials, examine rejection reasons and prepare detailed appeals with supplementary documentation when required.
Manage related procedures: When additional treatments occur, like TMJ injections (D7840), verify each procedure has separate documentation to prevent bundling complications.
How dental practices use D7870
Practice Example: A 35-year-old individual reports ongoing right TMJ discomfort and restricted opening following three months of appliance therapy and anti-inflammatory medication. Physical examination shows joint sensitivity and opening deviation. MRI reveals joint fluid accumulation. The clinician records unsuccessful conservative treatment, examination results, and imaging findings. Arthrocentesis proceeds using local anesthesia, including irrigation and manipulation. The claim includes D7870, supporting records, and ICD-10 code M26.621 (TMJ disorder, right side). Insurance initially seeks additional information, but after providing extra clinical records and imaging, the claim receives full approval and payment.
This scenario demonstrates the significance of complete documentation, benefit confirmation, and determination throughout the D7870 claim process.
Common Questions
Is it possible to submit D7870 claims to both dental and medical insurance providers?
D7870 can often be submitted to both dental and medical insurance carriers, though this depends on the patient's specific coverage details and policy terms related to TMJ disorder treatments. Medical insurance may provide coverage for TMJ procedures under certain circumstances, while some policies may have exclusions. It's essential to verify benefits with both insurance types before performing the procedure and check for any pre-authorization requirements while coordinating benefits to prevent duplicate billing issues.
What are typical reasons for D7870 claim denials?
D7870 claims are frequently denied due to inadequate documentation, insufficient evidence of unsuccessful conservative treatment attempts, missing pre-authorization when mandated by the payer, or inappropriate billing alongside other TMJ procedure codes without proper clinical justification. Maintaining comprehensive documentation and adhering to each payer's specific requirements can significantly minimize denial risks.
What are the billing frequency limitations for D7870 per patient?
D7870 billing frequency varies based on clinical necessity and individual insurance policy restrictions. Certain payers limit coverage to one procedure per joint annually, while others permit additional procedures when medically warranted with appropriate clinical documentation. It's crucial to examine the patient's specific policy terms and provide comprehensive clinical rationale for any subsequent procedures.