Understanding Dental Code D7490

When to Use D7490 dental code

The D7490 dental code is designated for the radical resection of the maxilla or mandible. This CDT code is used when a dentist or oral surgeon must remove a significant portion of the upper (maxilla) or lower (mandible) jaw, typically due to aggressive pathology such as malignant tumors, extensive infections, or severe trauma. Unlike routine extractions or minor bone removal, D7490 applies when the procedure involves the removal of a large segment of bone with or without immediate reconstruction. It is crucial to distinguish D7490 from codes for simple extractions or less extensive surgical procedures to ensure accurate billing and compliance.

Documentation and Clinical Scenarios

Proper documentation is essential for successful reimbursement when using D7490. Clinical notes should include:

• Detailed diagnosis (e.g., type and location of tumor, extent of infection, or nature of trauma)
• Preoperative imaging and findings (such as radiographs or CT scans)
• Operative report specifying the area and amount of bone resected
• Any related procedures performed (e.g., reconstruction, grafting)
• Pathology reports, if applicable

Common clinical scenarios for D7490 include resection due to oral cancer, osteomyelitis, or severe jaw fractures. Always ensure that the clinical necessity is clearly justified in the patient record to support the use of this advanced surgical code.

Insurance Billing Tips

Billing for D7490 requires attention to detail and proactive communication with payers. Here are best practices to maximize claim approval:

• Preauthorization: Always submit a preauthorization request with supporting documentation, including clinical notes, imaging, and a clear treatment plan. Many insurers require this for major surgical procedures.
• Attach Supporting Evidence: Include operative reports, pathology results, and images with the claim submission to demonstrate medical necessity.
• Use Correct Coding: Ensure D7490 is not confused with codes for less extensive procedures, such as removal of residual tooth roots (D7250) or alveoloplasty (D7310).
• Follow Up: Monitor the claim status in your AR system and be prepared to respond promptly to requests for additional information or to initiate a claim appeal if denied.

Clear, thorough documentation and proactive communication with insurance carriers are key to minimizing delays and denials for D7490 claims.

Example Case for D7490

Case Study: A 58-year-old patient presents with a rapidly growing lesion in the left posterior mandible. Imaging confirms a malignant tumor extending into the jawbone. After multidisciplinary consultation, the oral surgeon performs a radical resection of the affected mandible, removing the tumor and involved bone. The procedure is documented in detail, including preoperative imaging, intraoperative findings, and the extent of resection. The office submits a preauthorization request and, upon approval, bills the procedure using D7490, attaching all supporting records. The claim is processed successfully, and the practice receives timely reimbursement.

This example highlights the importance of comprehensive documentation, correct code selection, and diligent insurance follow-up when billing for complex surgical procedures like D7490.