When is D7983 used?
The D7983 dental code applies to the repair of a salivary fistula, a treatment needed when an irregular pathway forms between a salivary gland or duct and the mouth or skin surface. Dental professionals should apply D7983 when patients have ongoing salivary drainage after injury, surgical procedures, or infections that created a fistulous opening. Selecting the correct code is vital for proper billing and guarantees appropriate reimbursement for the treatment. Always verify that the patient's condition aligns with the code's purpose and that no other CDT code better describes the treatment performed.
D7983 Charting and Clinical Use
Complete and detailed record-keeping is essential when submitting claims for D7983. The patient records must clearly outline:
The site and cause of the salivary fistula
Medical background, including previous procedures, injuries, or infections
Assessment results (such as x-rays, physical examination)
The exact method used for repair (such as surgical removal, multi-layer closure)
Recovery guidelines and monitoring schedule
Typical situations include repair following salivary stone removal, reconstruction after oral tumor surgery, or fixing a continuing fistula following tooth extractions. When additional treatments are done simultaneously, like a bone grafting procedure, record each treatment individually and confirm each is clinically required.
Billing and Insurance Considerations
To improve payment success and reduce claim rejections for D7983, dental office staff should:
Confirm benefits: Review the patient's insurance plan for oral surgery coverage and any limitations on fistula repair treatments.
Obtain prior approval: Send comprehensive pre-authorization requests with patient records, x-rays, and written explanation of why the repair is medically required.
Include supporting materials: Attach mouth photographs, diagnostic images, and surgery reports with the insurance claim.
Challenge rejections: When claims are denied, examine the benefits explanation for rejection reasons, collect extra supporting evidence, and file a detailed appeal letter citing the CDT code definition and treatment necessity.
Monitor outstanding claims: Keep close watch on unpaid surgical procedure claims, as these typically need extra insurance company follow-up.
Being proactive with insurance verification and record-keeping helps avoid processing delays and ensures prompt payment for advanced surgical treatments like D7983.
How dental practices use D7983
Case: A 58-year-old patient has continuous fluid leakage from the lower jaw area three weeks following removal of a back molar. Clinical examination and diagnostic imaging reveal a salivary fistula from the submandibular duct. The oral surgeon completes a multi-layer surgical repair of the fistula using local numbing.
Billing process:
Record the examination results, diagnostic images, and surgical method in the patient's file.
Process claim with D7983, including patient records, x-rays, and mouth photographs.
Add written explanation describing the origin (extraction complication), the need for repair, and anticipated results.
Check with insurance company regarding pre-authorization status and quickly address any information requests.
This method ensures the claim has strong supporting documentation and improves the chances of successful payment.
Common Questions
Can D7983 be billed together with other dental procedure codes?
Yes, D7983 can be billed with other dental codes when additional procedures are performed during the same surgical appointment. For instance, if bone grafting or tissue reconstruction is needed along with salivary fistula closure, these procedures should be documented and coded separately. However, ensure each procedure is medically necessary and not included in the global surgical service. Always verify payer guidelines to prevent unbundling or duplicate billing complications.
What is the proper approach for obtaining pre-authorization for D7983?
Dental practices should reach out to the patient's insurance carrier before performing the procedure to verify if pre-authorization is needed for D7983. This typically requires submitting clinical records, diagnostic imaging, and a comprehensive narrative justifying the procedure's necessity. Securing pre-authorization helps prevent claim rejections and facilitates smoother payment processing. Make sure to maintain records of all insurer communications for future reference.
What are typical causes for D7983 claim denials?
Frequent denial reasons include inadequate documentation, failure to establish medical necessity, incomplete or unclear surgical reports, and billing the code for conditions excluded from the patient's coverage. Claims may also face rejection if the procedure is deemed part of a prior surgery or if the insurance plan does not cover surgical closure of salivary fistulas. Thoroughly reviewing the Explanation of Benefits and addressing specific denial reasons in appeals is essential for successful claim resolution.