Understanding Dental Code D7874

When to Use D7874 dental code

The D7874 dental code is designated for arthroscopy: disc repositioning and stabilization procedures within the temporomandibular joint (TMJ). This CDT code should be used when a provider performs minimally invasive arthroscopic surgery to reposition and stabilize the articular disc, often to address TMJ dysfunction, pain, or locking that has not responded to conservative therapies. Proper use of D7874 ensures accurate reporting and reimbursement for this advanced surgical intervention.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing for D7874. Clinical notes must clearly indicate:

• The patient’s diagnosis and symptoms (e.g., disc displacement, chronic TMJ pain, limited jaw movement).
• Conservative treatments attempted and their outcomes (physical therapy, splints, medications).
• Imaging findings supporting the need for arthroscopic intervention (MRI or CT showing disc displacement).
• Details of the procedure, including the use of arthroscopy, disc repositioning, and stabilization techniques.
• Postoperative care instructions and follow-up plan.

Common clinical scenarios include patients with persistent TMJ pain, jaw locking, or functional limitations that have not improved with non-surgical management. Thorough documentation not only supports the claim but also streamlines the insurance approval process and reduces the risk of denials.

Insurance Billing Tips

Billing for D7874 requires attention to detail and proactive communication with payers. Here are best practices for successful claims:

• Insurance Verification: Before scheduling the procedure, verify the patient’s benefits and confirm TMJ coverage, as many plans have specific exclusions or requirements for TMJ surgeries.
• Pre-authorization: Obtain pre-authorization or pre-determination from the payer, submitting all supporting documentation, including clinical notes, imaging, and a detailed treatment plan.
• Claim Submission: Use the correct CDT code (D7874) and ensure all required attachments are included. Double-check for coding accuracy and completeness.
• EOB Review: Carefully review the Explanation of Benefits (EOB) for payment accuracy and denial reasons. If denied, review the payer’s policy and prepare a thorough appeal with additional documentation if needed.
• Coordination of Benefits: If the patient has dual coverage, coordinate benefits to maximize reimbursement and minimize patient out-of-pocket costs.

Staying current with payer policies and maintaining organized records are key to minimizing Accounts Receivable (AR) days and ensuring prompt reimbursement.

Example Case for D7874

Case: A 32-year-old patient presents with chronic right-sided TMJ pain and jaw locking. Conservative treatments, including splint therapy and anti-inflammatory medications, have failed. MRI confirms anterior disc displacement without reduction. The oral surgeon performs arthroscopic disc repositioning and stabilization. Detailed operative notes, pre- and post-op imaging, and a letter of medical necessity are submitted to the insurance carrier. Pre-authorization is obtained, and the claim is submitted with D7874. The payer approves the claim, and payment is received within 30 days.

This example highlights the importance of thorough documentation, proper code selection, and proactive insurance communication for successful reimbursement when using D7874.