When is D7873 used?
The D7873 dental code applies to arthroscopy: lavage and lysis of adhesions for the temporomandibular joint (TMJ). This CDT code is utilized when practitioners conduct a minimally invasive procedure to flush the TMJ and dissolve intra-articular adhesions that limit jaw function or create discomfort. D7873 does not cover diagnostic arthroscopy by itself or open surgical procedures; it specifically relates to therapeutic irrigation and adhesion removal using arthroscopic methods.
Typical uses include TMJ conditions with verified adhesions, reduced jaw mobility, or ongoing discomfort that hasn't responded to non-surgical treatment. Always verify medical necessity and ensure the procedure aligns with the code's specifications before using D7873 for claims submission.
D7873 Charting and Clinical Use
Proper documentation is essential for successful payment of D7873. The patient record must contain:
Comprehensive diagnosis indicating TMJ adhesions or malfunction
Non-surgical treatments tried and their results
Pre-surgical imaging or examination results showing adhesions
Surgical report detailing the arthroscopic method, irrigation, and adhesion removal
Post-surgical evaluation and care plan
For instance, a patient experiencing ongoing TMJ discomfort and restricted opening that didn't improve with appliances or therapy may receive imaging showing adhesions. When the practitioner conducts arthroscopic irrigation and adhesion removal, D7873 is the appropriate code. Always verify that documentation clearly distinguishes this treatment from other TMJ services, such as bite guard appliances or other TMJ treatments.
Billing and Insurance Considerations
Processing D7873 claims demands close attention to insurance guidelines and approval requirements. Here are recommended practices for improving claim acceptance:
Check benefits: Numerous dental and medical insurance plans treat TMJ arthroscopy as a medical service. Determine whether D7873 falls under the patient's dental or medical coverage before arranging the treatment.
Secure prior approval: Provide patient records, diagnostic images, and medical necessity documentation to the insurer. Explain clearly why conservative approaches were unsuccessful and why arthroscopic treatment is needed.
Apply proper coding: Combine D7873 with relevant diagnostic codes (ICD-10) and attach all supporting materials with the claim.
Monitor payments and outstanding claims: Review benefit statements for rejections or information requests. Respond quickly to prevent payment delays.
File appeals as needed: When claims are rejected, examine the benefit statement for reasons and file a comprehensive appeal with extra documentation when required.
How dental practices use D7873
Take a 35-year-old patient with ongoing TMJ discomfort and limited jaw function. Following months of conservative care (appliances, anti-inflammatory medications, therapy) with little progress, MRI reveals intra-articular adhesions. The oral surgeon conducts arthroscopic irrigation and adhesion removal. The surgical documentation describes the arthroscopic approach, observations, and post-treatment progress. The billing staff files the claim with D7873, includes all patient records, and secures prior approval. The claim receives approval, and payment arrives promptly.
Through proper understanding of when and how to apply the D7873 dental code, dental offices can maintain correct billing practices, minimize claim rejections, and deliver excellent patient treatment for TMJ conditions.
Common Questions
Can D7873 be used alongside other TMJ procedure codes?
D7873 covers arthroscopic lavage and lysis of adhesions for TMJ treatment. When additional procedures like synovectomy or disc repositioning occur during the same session, separate billing codes may apply. Since bundling regulations and insurance policies differ between providers, verify coverage with the patient's insurer and consult CDT guidelines to prevent billing conflicts or claim rejections.
What causes D7873 claims to be denied most frequently?
Frequent denial causes include inadequate documentation proving medical necessity, missing surgical reports, failure to obtain required pre-authorization, or incorrect code usage for procedures outside D7873's scope. Maintaining comprehensive documentation and adhering to insurer-specific guidelines helps minimize claim denials.
Do medical or dental insurance plans typically cover D7873?
D7873 coverage depends on the specific insurance provider. Many dental plans exclude TMJ treatments, while some medical insurance policies may provide coverage when medical necessity is demonstrated. Always confirm benefits and coverage details with the patient's insurance company prior to performing the procedure.