Understanding Dental Code D7240

When to Use D7240 dental code

The D7240 dental code is used to report the removal of an impacted tooth, specifically when the tooth is fully bony and requires a surgical approach for extraction. This CDT code applies when the impacted tooth is completely covered by bone, necessitating the elevation of a mucoperiosteal flap, removal of bone, and sectioning of the tooth for removal. Most commonly, D7240 is used for third molars (wisdom teeth), but it can apply to any tooth meeting these criteria. Accurate use of D7240 ensures proper reimbursement and compliance with dental insurance policies.

Documentation and Clinical Scenarios

Thorough documentation is essential when billing D7240. Clinical notes should clearly describe the extent of impaction (full bony), the need for surgical intervention, and the specific steps taken during the procedure. Include preoperative radiographs, such as panoramic or periapical images, to demonstrate the tooth’s position and level of impaction. In your clinical narrative, detail the surgical approach, including flap elevation, bone removal, and tooth sectioning. Common scenarios for D7240 include removal of horizontally or mesioangularly impacted third molars that are entirely encased in bone, or any other tooth with similar impaction and surgical requirements.

Insurance Billing Tips

To maximize claim acceptance for D7240, follow these best practices:

• Verify coverage: Confirm the patient’s benefits and frequency limitations for surgical extractions before treatment.
• Submit comprehensive documentation: Attach clinical notes, radiographs, and intraoral photos to support the claim.
• Use accurate coding: Do not upcode or downcode; use D7240 only when the tooth is fully bony impacted and requires surgical removal. For soft tissue impactions, consider D7220 or D7230 as appropriate.
• Appeal denials: If a claim is denied, review the EOB for reasons, gather additional documentation, and submit a detailed appeal letter explaining the clinical necessity of D7240.

Consistent, detailed documentation and proactive communication with payers can significantly reduce AR days and improve reimbursement rates.

Example Case for D7240

A 25-year-old patient presents with pain and swelling in the lower right jaw. Panoramic radiograph reveals a horizontally impacted mandibular third molar, fully encased in bone. After verifying insurance coverage, the provider documents the surgical plan: elevation of a full-thickness mucoperiosteal flap, removal of buccal and distal bone, sectioning of the tooth, and careful extraction. Clinical notes and radiographs are submitted with the claim using D7240. The claim is approved, and payment is received promptly due to thorough documentation and correct code selection.