Understanding Dental Code D3920

When to Use D3920 dental code

The D3920 dental code is designated for a procedure known as a hemisection, which involves the surgical removal of one root and the corresponding portion of the crown of a multi-rooted tooth. This code specifically excludes root canal therapy, so it should only be used when the hemisection is performed without concurrent endodontic treatment. Common clinical indications include severe bone loss, root fracture, or localized infection affecting only one root of a tooth, most often mandibular molars. Proper use of D3920 ensures accurate reporting and reimbursement for this specialized surgical service.

Documentation and Clinical Scenarios

Accurate documentation is critical when submitting claims for D3920. The clinical record should include:

• A detailed diagnosis justifying the hemisection (e.g., localized periodontal disease or root fracture).
• Pre-operative radiographs showing the condition of the affected root(s).
• A narrative describing the surgical procedure, specifying which root and crown portion were removed.
• Post-operative notes and follow-up care instructions.

Typical scenarios for D3920 include a molar with one non-restorable root while the remaining root is healthy enough to support a restoration or prosthesis. For instance, if a patient presents with a vertical root fracture on the distal root of a mandibular first molar, but the mesial root is stable, a hemisection may be the best treatment option.

Insurance Billing Tips

Billing for D3920 requires attention to detail to avoid claim denials or delays. Here are best practices:

• Verify coverage: Before treatment, confirm with the patient’s insurer whether hemisection (D3920) is a covered benefit and if any pre-authorization is required.
• Submit comprehensive documentation: Attach diagnostic radiographs and a clear clinical narrative to your claim. This supports medical necessity and reduces the risk of denial.
• Use correct CDT codes: Do not bundle D3920 with root canal therapy codes such as anterior root canal or molar root canal. Bill these procedures separately if performed at different appointments.
• Monitor EOBs and AR: Review Explanation of Benefits (EOBs) for correct processing and promptly follow up on any denied or underpaid claims. Maintain accurate accounts receivable (AR) tracking for all surgical codes.
• Appeal when necessary: If a claim is denied, submit an appeal with additional documentation, such as detailed narratives and supporting radiographs, to demonstrate the necessity of the hemisection.

Example Case for D3920

Consider a patient with a mandibular first molar exhibiting advanced bone loss around the distal root due to localized periodontitis, while the mesial root remains healthy. The dentist determines that a hemisection is the best option to preserve part of the tooth. The procedure involves surgically removing the distal root and its associated crown segment, followed by restoration of the remaining tooth structure. The dental office submits a claim using D3920, including pre- and post-operative radiographs and a detailed narrative. The insurer approves the claim, and the patient receives a functional restoration, demonstrating the clinical and financial value of accurate coding and documentation.