Understanding Dental Code D7871

When to Use D7871 dental code

The D7871 dental code is designated for non-arthroscopic lysis and lavage of the temporomandibular joint (TMJ). This procedure is performed to address TMJ disorders by flushing the joint space and breaking up adhesions without the use of an arthroscope. Dental practices should use D7871 when a patient presents with TMJ dysfunction that has not responded to conservative treatments, and the provider determines that non-arthroscopic lysis and lavage is medically necessary. It is important to differentiate this code from other TMJ-related CDT codes, such as D7880 (occlusal orthotic device), to ensure accurate billing and avoid claim denials.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful reimbursement of D7871. Providers should include:

• Detailed clinical notes describing the patient’s TMJ symptoms, prior treatments, and the rationale for performing lysis and lavage.
• Pre- and post-procedure findings, including range of motion, pain levels, and functional improvements.
• Radiographs or imaging reports, if available, to support the diagnosis and necessity of the procedure.
• Step-by-step description of the procedure performed, including the solution used for lavage and the technique for lysis.

Common clinical scenarios include patients with chronic TMJ pain, restricted jaw movement, or joint noises that have not improved with splints, medications, or physical therapy. Properly documenting failed conservative care is crucial for insurance approval.

Insurance Billing Tips

To maximize reimbursement and minimize delays, follow these best practices:

• Verify coverage: Before scheduling the procedure, check with the patient’s dental and medical insurance to confirm if D7871 is a covered benefit. Some plans may require pre-authorization or a referral.
• Submit supporting documentation: Always include clinical notes, diagnostic imaging, and a narrative explaining medical necessity with your claim. This reduces the risk of denials and requests for additional information.
• Use correct coding: Ensure D7871 is not billed in conjunction with codes for arthroscopic procedures or unrelated TMJ treatments on the same date of service.
• Appeal denied claims: If you receive an EOB (Explanation of Benefits) with a denial, review the reason code, supplement your documentation, and submit a timely appeal. Attach all supporting evidence and a detailed appeal letter outlining the clinical justification for the procedure.

Example Case for D7871

Case: A 32-year-old patient experiences persistent jaw pain and limited opening despite six months of conservative therapy. Clinical evaluation and imaging confirm intra-articular adhesions. The provider performs non-arthroscopic lysis and lavage (D7871), thoroughly documents the patient’s history, failed prior treatments, and the procedure details. The claim is submitted with all supporting documents, resulting in prompt insurance approval and payment.

This example highlights the importance of comprehensive documentation, insurance verification, and correct code usage for successful billing of D7871.