When is D7979 used?
The D7979 dental code applies to non-surgical sialolithotomy, which involves removing salivary stones (sialoliths) from salivary glands or ducts through non-invasive methods. This code is suitable when the procedure uses minimally invasive approaches like manual expression, duct dilation, or specialized instruments to extract stones. Surgical intervention requiring incisions would necessitate a different CDT code instead of D7979.
D7979 Charting and Clinical Use
Proper documentation is essential for successful claim processing when using D7979. Clinical records must clearly include:
Patient's symptoms at presentation (such as swelling, pain, or salivary gland obstruction)
Diagnostic procedures confirming sialolith presence and location
The particular non-surgical method employed for stone removal
Post-treatment assessment and patient care instructions
Typical clinical situations involve patients with detectable stones in submandibular or parotid ducts that are accessible for removal without surgical incision. Include pre- and post-treatment images or radiographs when possible, as these documents can validate the procedure's necessity and effectiveness during insurance reviews or appeals.
Billing and Insurance Considerations
When processing claims for D7979, implement these strategies to improve acceptance rates and reduce denials:
Confirm coverage: Non-surgical sialolithotomy isn't covered by all dental insurance plans. Check patient benefits and plan limitations prior to treatment.
Obtain pre-authorization: For complicated cases or comprehensive plans, secure pre-authorization with clinical documentation and diagnostic imaging.
Complete claim documentation: Include a narrative explaining patient symptoms, diagnostic results, and the non-surgical approach used. Provide supporting materials like radiographs or clinical photographs.
Handle claim denials: When claims are rejected, examine the Explanation of Benefits for denial reasons and file a comprehensive appeal with additional supporting evidence.
Consider medical billing: In specific situations where medical coverage applies, use appropriate ICD-10-CM diagnosis codes and file medical claims alongside dental claims.
How dental practices use D7979
Case: A 45-year-old patient reports periodic swelling and pain in the mouth floor. Clinical assessment and periapical X-ray reveal a small sialolith in the submandibular duct. The practitioner employs careful duct dilation and manual expression to extract the stone without making an incision. The patient receives post-treatment care guidelines and a follow-up appointment.
Processing steps:
Confirm patient's dental insurance coverage for D7979 procedures.
Record clinical observations, diagnostic images, and non-surgical removal methods in patient records.
File the claim using D7979, including narrative description and all supporting materials.
For denied claims, examine the EOB and file an appeal with extra clinical evidence and imaging.
Following these procedures helps dental offices ensure proper billing practices and enhance the probability of prompt reimbursement for non-surgical sialolithotomy treatments.
Common Questions
Does medical insurance cover D7979 or is it limited to dental insurance only?
D7979 falls under CDT (Current Dental Terminology) coding, making it typically billable to dental insurance carriers. In exceptional circumstances where the treatment is medically necessary and dental coverage is unavailable, certain medical insurance plans might provide reimbursement when submitted with proper cross-coding and comprehensive medical documentation. It's essential to confirm coverage with the patient's individual insurance provider prior to claim submission.
Is it possible to bill D7979 alongside other dental treatments performed during the same visit?
Yes, D7979 may be billed concurrently with additional dental procedures when each treatment is distinctly separate and properly documented. Clinical documentation must clearly distinguish between procedures and establish medical necessity for each service. Be aware that certain insurance providers may require supplementary documentation or could bundle services together, so review payer-specific guidelines and prepare for potential appeals when necessary.
What typically causes D7979 claim denials and what steps prevent them?
Frequent denial causes include inadequate documentation, missing radiographic support, vague clinical narratives, or insurance determination that the procedure was surgical rather than non-surgical in nature. Prevention strategies include comprehensive clinical documentation, supporting radiographs or imaging, detailed descriptions of non-surgical methodology, and clear narratives explaining why surgical intervention was unnecessary. Obtaining pre-authorization and maintaining proactive insurer communication significantly reduces denial probability.