When is D7871 used?
The D7871 dental code applies to non-arthroscopic lysis and lavage of the temporomandibular joint (TMJ). This treatment involves cleaning the joint space and releasing adhesions without using an arthroscope. Dental offices should apply D7871 for patients with TMJ problems that haven't improved with basic treatments, when the dentist decides that non-arthroscopic lysis and lavage is clinically needed. It's crucial to distinguish this code from other TMJ-related CDT codes, like D7880 (occlusal orthotic device), to maintain proper billing practices and prevent claim rejections.
D7871 Charting and Clinical Use
Proper documentation is vital for successful payment of D7871. Providers must include:
Complete clinical records showing the patient's TMJ signs, previous treatments, and reasons for choosing lysis and lavage.
Before and after procedure results, including jaw movement range, pain scores, and functional changes.
X-rays or imaging studies, when available, to justify the diagnosis and treatment necessity.
Detailed procedure description, including lavage solution type and lysis methods used.
Typical clinical situations involve patients with ongoing TMJ discomfort, limited jaw opening, or joint sounds that haven't responded to appliances, medications, or therapy. Recording unsuccessful conservative treatment is essential for insurance acceptance.
Billing and Insurance Considerations
To improve payment success and reduce processing delays, use these strategies:
Check benefits: Prior to procedure scheduling, contact the patient's dental and medical carriers to verify D7871 coverage. Some policies may need prior approval or specialist referral.
Include supporting records: Always attach clinical documentation, diagnostic images, and a detailed explanation of medical need with your claim. This prevents denials and information requests.
Apply proper coding: Make sure D7871 isn't billed with arthroscopic procedure codes or unrelated TMJ services on the same treatment date.
Challenge rejected claims: When receiving an EOB showing denial, examine the denial reason, add more documentation, and file a prompt appeal. Include all supporting materials and a comprehensive appeal letter explaining the clinical need for treatment.
How dental practices use D7871
Situation: A 32-year-old patient has ongoing jaw discomfort and restricted opening after six months of basic treatment. Examination and imaging show joint adhesions inside the TMJ. The dentist performs non-arthroscopic lysis and lavage (D7871), carefully records the patient's background, unsuccessful previous care, and procedure specifics. The claim gets filed with complete supporting materials, leading to quick insurance acceptance and reimbursement.
This situation shows how thorough documentation, benefit verification, and accurate coding lead to successful D7871 billing.
Common Questions
Is D7871 classified as a medical or dental procedure for insurance billing?
D7871 may be covered under dental or medical insurance plans, depending on your specific policy terms and coverage details. Since TMJ treatments often exist in a coverage overlap between dental and medical benefits, it's essential for dental practices to confirm with your insurance provider whether D7871 is covered under dental benefits, medical benefits, or potentially both. The billing process should then follow the appropriate procedures for your specific insurance type.
What preparation is needed before undergoing the D7871 procedure?
Patients typically need to follow certain pre-procedure guidelines, which may include fasting for a specified time period, temporarily stopping certain medications, or arranging transportation home if sedation will be administered. Your healthcare provider will provide detailed pre-procedure and post-procedure instructions customized to your individual health condition and the specific details of your scheduled lysis and lavage treatment.
What is the expected recovery timeline following a D7871 TMJ lysis and lavage?
Recovery duration can vary between patients, though most individuals experience mild discomfort and swelling lasting several days following the procedure. The majority of patients can resume regular activities within approximately one week. Healthcare providers typically recommend maintaining a soft food diet, performing gentle jaw movement exercises, and attending scheduled follow-up visits to assess healing progress and jaw function. Any ongoing pain or unusual symptoms should be communicated to your provider immediately.