Understanding Dental Code D7870

When to Use D7870 dental code

The D7870 dental code is designated for arthrocentesis of the temporomandibular joint (TMJ). This procedure involves lavage of the joint space with or without manipulation, typically performed to relieve pain, improve jaw function, and address TMJ disorders that have not responded to less invasive treatments. Dental teams should use D7870 when a patient presents with TMJ symptoms—such as pain, limited jaw movement, or joint noises—that are refractory to conservative therapies like splints or medications, and when clinical evaluation and imaging indicate joint effusion or internal derangement.

Documentation and Clinical Scenarios

Accurate documentation is critical for successful reimbursement of D7870. Your clinical notes should include:

• Detailed patient history, including failed conservative treatments
• Clinical findings (e.g., joint tenderness, limited opening, deviation)
• Diagnostic imaging results supporting TMJ involvement
• A clear description of the arthrocentesis procedure, including anesthesia used, number of needle insertions, and any medications administered intra-articularly
• Post-procedure instructions and follow-up plan

Common clinical scenarios for D7870 include acute or chronic TMJ pain unresponsive to splint therapy, suspected joint adhesions, or inflammatory joint disorders. Always ensure the medical necessity is well-documented, as insurers often request supporting evidence before approving reimbursement.

Insurance Billing Tips

Billing for D7870 requires attention to detail and a proactive approach. Here are best practices:

• Verify benefits: Before scheduling arthrocentesis, contact the patient’s dental and medical insurance to confirm coverage for TMJ procedures. Some plans may require pre-authorization or only cover under medical benefits.
• Submit comprehensive claims: Attach clinical notes, imaging reports, and a detailed narrative explaining the medical necessity. Use the correct CDT code (D7870) and cross-reference with ICD-10 codes for TMJ disorders.
• Monitor EOBs and AR: After claim submission, track Explanation of Benefits (EOBs) and follow up on Accounts Receivable (AR) promptly. If denied, review the denial reason and prepare a thorough claim appeal with additional documentation as needed.
• Coordinate with related codes: If other procedures are performed, such as TMJ injections (D7840), ensure each code is billed with distinct documentation to avoid bundling issues.

Example Case for D7870

Case Study: A 35-year-old patient presents with persistent right-sided TMJ pain and limited opening after three months of splint therapy and NSAIDs. Clinical exam reveals joint tenderness and deviation on opening. MRI confirms joint effusion. The provider documents failed conservative care, clinical findings, and imaging. Arthrocentesis is performed under local anesthesia, with lavage and manipulation. The claim is submitted with D7870, supporting documentation, and ICD-10 code M26.621 (TMJ disorder, right side). Insurance initially requests more information, but after submitting additional clinical notes and imaging, the claim is approved and paid in full.

This example highlights the importance of thorough documentation, benefit verification, and persistence in the claim process for D7870.