Understanding Dental Code D7873

When to Use D7873 dental code

The D7873 dental code is designated for arthroscopy: lavage and lysis of adhesions within the temporomandibular joint (TMJ). This CDT code should be used when a provider performs a minimally invasive procedure to irrigate the TMJ and break down intra-articular adhesions that restrict jaw movement or cause pain. D7873 is not appropriate for diagnostic arthroscopy alone or for open joint procedures; it specifically applies to therapeutic lavage and lysis performed via arthroscopic technique.

Common indications include TMJ disorders with confirmed adhesions, limited mandibular mobility, or persistent pain unresponsive to conservative therapy. Always confirm clinical necessity and ensure the procedure matches the code’s description before selecting D7873 for billing.

Documentation and Clinical Scenarios

Accurate documentation is critical for successful reimbursement of D7873. The clinical record should include:

• Detailed diagnosis supporting TMJ adhesions or dysfunction
• Conservative treatments attempted and their outcomes
• Pre-operative imaging or findings confirming adhesions
• Operative report describing the arthroscopic approach, lavage, and lysis of adhesions
• Post-operative assessment and follow-up plan

For example, a patient with chronic TMJ pain and limited opening not relieved by splints or physical therapy may undergo imaging that reveals adhesions. If the provider performs an arthroscopic lavage and lysis, D7873 is the correct code. Always ensure the documentation clearly differentiates this procedure from other TMJ interventions, such as occlusal orthotic devices or unspecified TMJ procedures.

Insurance Billing Tips

Billing D7873 requires careful attention to payer policies and preauthorization requirements. Here are best practices for maximizing claim approval:

• Verify coverage: Many dental and medical plans consider TMJ arthroscopy a medical benefit. Confirm if D7873 is covered under the patient’s dental or medical policy before scheduling the procedure.
• Obtain preauthorization: Submit clinical notes, imaging, and a letter of medical necessity to the insurer. Clearly state why conservative measures failed and why arthroscopic intervention is required.
• Use correct coding: Pair D7873 with appropriate diagnostic codes (ICD-10) and include all supporting documentation with the claim.
• Track EOBs and AR: Monitor Explanation of Benefits (EOBs) for denials or requests for additional information. Follow up promptly to avoid delays in Accounts Receivable (AR).
• Appeal when necessary: If a claim is denied, review the EOB for the reason and submit a detailed appeal with additional documentation as needed.

Example Case for D7873

Consider a 35-year-old patient presenting with persistent TMJ pain and restricted jaw movement. After months of conservative management (splints, NSAIDs, physical therapy) with minimal improvement, MRI confirms intra-articular adhesions. The oral surgeon performs arthroscopic lavage and lysis of adhesions. The operative note details the arthroscopic technique, findings, and post-procedure improvement. The billing team submits the claim using D7873, attaches all clinical documentation, and obtains preauthorization. The claim is approved, and reimbursement is received without delay.

By understanding when and how to use the D7873 dental code, dental practices can ensure accurate billing, reduce denials, and support optimal patient care for TMJ disorders.