Understanding Dental Code D3426

When to Use D3426 dental code

The D3426 dental code is designated for an apicoectomy on each additional root during endodontic surgery. This CDT code should be used when a tooth with multiple roots requires apical surgery on more than one root. For the first root, use the primary apicoectomy code, and then D3426 for each additional root treated in the same session. This ensures accurate reporting and reimbursement for the complexity of the procedure.

Documentation and Clinical Scenarios

Proper documentation is essential for successful claims. When billing D3426, your clinical notes must clearly indicate:

• The specific tooth number treated
• The number of roots involved
• Rationale for apicoectomy on each root (e.g., persistent infection, failed previous endodontic therapy)
• Radiographic evidence supporting the need for surgery

Common scenarios for D3426 include multi-rooted teeth such as maxillary molars or mandibular molars where infection or pathology affects more than one root apex. Always ensure your documentation matches the clinical reality and supports the necessity of the procedure.

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D3426:

• Verify the patient’s benefits and any frequency limitations for endodontic surgery before treatment.
• Submit detailed clinical notes and pre- and post-operative radiographs with the initial claim.
• Clearly differentiate between the primary root (billed with D3421) and additional roots (billed with D3426).
• Use accurate tooth numbers and specify which roots were treated.
• Review the Explanation of Benefits (EOB) carefully for any partial denials, and be prepared to submit a claim appeal with additional documentation if necessary.

Successful dental offices often use a checklist for required documentation and train their team to flag multi-rooted cases for proper coding.

Example Case for D3426

Consider a patient presenting with a persistent periapical lesion on tooth #19, a mandibular molar with two roots. The endodontist performs an apicoectomy on both the mesial and distal roots. In this scenario:

• D3421 is billed for the first root (e.g., mesial root).
• D3426 is billed for the additional root (e.g., distal root).

The clinical notes should specify the procedure on each root, include supporting radiographs, and detail the medical necessity. This approach ensures accurate coding, supports the claim, and improves the likelihood of full reimbursement.