Understanding Dental Code D7946

When to Use D7946 dental code

The D7946 dental code, officially known as "LeFort I (maxilla) – without bone graft," is used to report surgical procedures involving the repositioning of the upper jaw (maxilla) through a LeFort I osteotomy. This CDT code is appropriate when a patient requires correction of maxillary deformities, such as malocclusion, open bite, or facial asymmetry, and the procedure does not include a bone graft. Typically, oral and maxillofacial surgeons perform this surgery to improve function, aesthetics, or both. Proper use of D7946 ensures accurate claim submission and reimbursement for these complex surgical interventions.

Documentation and Clinical Scenarios

Accurate documentation is critical when billing for D7946. Clinical notes should clearly describe the diagnosis (e.g., skeletal Class III malocclusion), the surgical plan, and the specific steps of the LeFort I osteotomy performed. Include preoperative radiographs, cephalometric analyses, and photographic records to support medical necessity. Common clinical scenarios for D7946 include correction of congenital jaw discrepancies, trauma-related deformities, and cases where orthodontic treatment alone is insufficient. Always ensure that the operative report details that no bone graft was placed, as this distinguishes D7946 from related codes such as D7950 (bone graft for reconstruction).

Insurance Billing Tips

Successful reimbursement for D7946 requires a proactive approach. Begin with thorough insurance verification to confirm coverage for orthognathic surgery and obtain preauthorization when possible. Submit a comprehensive claim package, including clinical documentation, diagnostic images, and a detailed narrative explaining the medical necessity. If the claim is denied, review the Explanation of Benefits (EOB) for specific reasons and prepare a targeted appeal with additional supporting evidence. Be aware that some payers may classify LeFort I procedures as medical rather than dental, so coordinate with both dental and medical insurance as needed. Track accounts receivable (AR) closely to ensure timely follow-up on outstanding claims.

Example Case for D7946

Consider a 22-year-old patient with a severe open bite and maxillary hypoplasia. After interdisciplinary consultation, the oral surgeon determines that a LeFort I osteotomy (without bone graft) is required. The dental office collects preoperative records, verifies insurance benefits, and submits a preauthorization request with all supporting documentation. Following surgery, the claim is submitted with the D7946 code, operative report, and before-and-after images. The insurance initially denies the claim, citing lack of medical necessity. The office promptly appeals, providing additional cephalometric analysis and a letter from the orthodontist. The appeal is successful, and the claim is paid in full, demonstrating the importance of detailed documentation and persistent follow-up in billing for D7946.