When is D7980 used?
The D7980 dental code is designated for surgical sialolithotomy procedures, involving the surgical extraction of salivary stones from ducts or glands. This CDT code applies when patients experience symptoms like swelling, discomfort, or infection caused by sialoliths that need surgical removal. It's essential to distinguish this code from other oral surgery procedures, including soft tissue removals or alternative gland treatments, to maintain proper billing accuracy and clinical documentation.
D7980 Charting and Clinical Use
Accurate documentation is essential for D7980 billing. Clinical records must contain:
Comprehensive patient history detailing symptoms and their timeline
Diagnostic evidence (such as X-rays or imaging studies verifying sialolith presence and position)
Surgical procedure documentation, including anesthetic type and stone extraction technique
Post-surgical care instructions and follow-up treatment plans
Typical clinical situations for D7980 involve patients experiencing recurring submandibular or parotid gland swelling, imaging-confirmed blockages, and unsuccessful conservative treatments (like gland massage or saliva stimulants). In such instances, surgical extraction becomes medically warranted and requires clear justification in patient records.
Billing and Insurance Considerations
To optimize reimbursement and reduce claim rejections for D7980:
Check coverage prior to treatment to confirm whether the patient's dental or medical insurance includes surgical sialolithotomy benefits. Some insurers may classify this as a medical treatment.
Include thorough documentation with claims, featuring clinical records, imaging studies, and detailed explanations of procedure necessity.
Apply the appropriate CDT code (D7980) and prevent improper code combinations with other surgical procedures unless multiple separate treatments occurred. When additional procedures like tissue sampling (biopsy code) are performed, record each service individually.
Examine Explanation of Benefits statements thoroughly. For denials, verify complete documentation or arrange peer-to-peer discussions when medical necessity is disputed.
Contest rejected claims quickly using additional supporting materials, including specialist recommendations or diagnostic imaging results.
How dental practices use D7980
Practice Example: A 45-year-old individual reports periodic jaw swelling, particularly during eating. Panoramic imaging shows a 6mm calcified deposit within the submandibular duct. After conservative approaches prove ineffective, the practitioner conducts surgical sialolithotomy using local anesthesia, successfully extracting the stone. Clinical documentation includes examination findings, surgical details, and aftercare plans. The practice files a claim using D7980, includes the radiographic evidence, and provides a detailed account of patient symptoms and unsuccessful conservative management. The claim receives approval and prompt payment.
This scenario demonstrates the significance of complete record-keeping, appropriate code usage, and effective insurer communication to achieve successful D7980 procedure reimbursement.
Common Questions
Can D7980 be billed with other dental procedure codes?
D7980 can be billed with other dental procedure codes when additional, separately identifiable procedures are performed during the same appointment (such as biopsy or incision and drainage). Each procedure must be properly documented as distinct and medically necessary. Always verify payer guidelines regarding bundling or unbundling requirements to prevent claim denials.
What causes D7980 claims to be denied?
Claims are commonly denied due to inadequate documentation, missing pre-authorization when required, billing the code for non-surgical treatment, or using D7980 for procedures outside the code's definition. Providing thorough clinical notes, supporting images, and detailed narratives helps reduce denial rates.
Is D7980 covered by medical insurance rather than dental insurance?
D7980 may qualify for medical insurance coverage when the procedure is medically necessary and extends beyond routine dental care. Coverage depends on the specific payer, so benefit verification and pre-authorization are essential when required. Include comprehensive supporting documentation to establish medical necessity.