Understanding Dental Code D7520

When to Use D7520 dental code

The D7520 dental code is designated for the incision and drainage of an abscess—specifically, intraoral soft tissue. This CDT code is used when a dentist needs to relieve a localized collection of pus caused by infection, typically presenting as swelling, pain, and sometimes fever. Use D7520 when the procedure involves making an incision inside the mouth to access and drain the abscess, but does not involve bone removal or extraoral approaches. It is important to differentiate D7520 from other codes, such as D7510 (incision and drainage of abscess, intraoral soft tissue—simple), to ensure accurate billing and clinical documentation.

Documentation and Clinical Scenarios

Accurate documentation is crucial for successful reimbursement and compliance. For D7520, the clinical notes should include:

• Patient’s chief complaint and symptoms (e.g., swelling, pain, fever)
• Clinical findings (location, size, and characteristics of the abscess)
• Diagnosis of abscess and decision for incision and drainage
• Description of the procedure: anesthesia used, incision site, drainage method, and any post-operative care instructions
• Follow-up plan and any prescribed medications

Common scenarios for D7520 include periodontal abscesses, pericoronal abscesses (around partially erupted teeth), and abscesses related to trauma or post-surgical infections. Always ensure the documentation clearly supports the necessity of the procedure and matches the code description.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D7520, follow these best practices:

• Verify patient benefits: Confirm coverage for oral surgery procedures prior to treatment. Some plans may have limitations or require pre-authorization.
• Submit complete claims: Attach detailed clinical notes, radiographs, and intraoral photos if available. This supports medical necessity and expedites claim processing.
• Use accurate coding: Double-check that D7520 is the most appropriate code for the procedure performed. Avoid upcoding or miscoding, as this can trigger audits or denials.
• Review EOBs promptly: If the claim is denied or underpaid, review the Explanation of Benefits (EOB) for the reason and file a timely appeal with additional documentation if needed.
• Track AR: Monitor accounts receivable to ensure timely payment and follow up on outstanding claims.

Staying proactive with insurance verification and thorough documentation are key to successful billing for D7520.

Example Case for D7520

Case Study: A 35-year-old patient presents with swelling and pain in the lower right molar area. Clinical examination reveals a fluctuant swelling on the buccal gingiva adjacent to tooth #30. The dentist diagnoses a periodontal abscess and determines that incision and drainage are necessary. After administering local anesthesia, the dentist makes a small incision intraorally, drains the pus, irrigates the area, and provides post-op instructions. The procedure is documented in detail, and D7520 is billed to the patient’s dental insurance with supporting clinical notes and photos. The claim is processed and paid without issue, thanks to accurate coding and thorough documentation.

By understanding when and how to use the D7520 dental code, dental offices can ensure proper reimbursement, minimize claim denials, and provide the best care for their patients.