Understanding Dental Code D7979

When to Use D7979 dental code

The D7979 dental code is designated for non-surgical sialolithotomy, which is the removal of a salivary stone (sialolith) from a salivary gland or duct without the need for surgical incision. This code is appropriate when the procedure is performed using minimally invasive techniques such as manual expression, duct dilation, or the use of specialized instruments to extract the stone. It should not be used if the removal requires surgical intervention, in which case a different CDT code may be more appropriate.

Documentation and Clinical Scenarios

Accurate documentation is critical for successful reimbursement when billing D7979. Clinical notes should clearly describe:

• The patient’s presenting symptoms (e.g., swelling, pain, or obstruction related to the salivary gland)
• The diagnostic process confirming the presence and location of the sialolith
• The specific non-surgical technique used for removal
• Post-procedure evaluation and patient instructions

Common clinical scenarios include patients with palpable stones in the submandibular or parotid duct that can be accessed and removed without incision. Always include pre- and post-operative images or radiographs if available, as these can support the necessity and success of the procedure in the event of an insurance claim review or appeal.

Insurance Billing Tips

When billing for D7979, follow these best practices to maximize claim acceptance and minimize denials:

• Verify coverage: Not all dental plans cover non-surgical sialolithotomy. Confirm benefits and any plan exclusions before treatment.
• Pre-authorization: For complex cases or higher-cost plans, obtain pre-authorization and include clinical documentation and diagnostic images.
• Detailed claim submission: Attach a narrative describing the patient’s symptoms, diagnostic findings, and the non-surgical technique used. Include supporting documentation such as radiographs or intraoral photographs.
• Appeal denials: If the claim is denied, review the Explanation of Benefits (EOB) for denial reasons and submit a detailed appeal with additional supporting documentation.
• Cross-coding: In rare cases where medical insurance may apply, use the appropriate ICD-10-CM diagnosis code and submit a medical claim form in addition to the dental claim.

Example Case for D7979

Case: A 45-year-old patient presents with intermittent swelling and discomfort in the floor of the mouth. Clinical examination and a periapical radiograph confirm a small sialolith in the submandibular duct. The dentist uses gentle duct dilation and manual expression to remove the stone without incision. The patient is provided with post-operative care instructions and scheduled for follow-up.

Billing steps:

1. Verify the patient’s dental benefits for D7979 coverage.
2. Document the clinical findings, diagnostic images, and the non-surgical removal technique in the patient’s chart.
3. Submit the claim with D7979, attaching a narrative and all supporting documentation.
4. If the claim is denied, review the EOB and submit an appeal with additional clinical justification and images.

By following these steps, dental teams can ensure accurate billing and improve the likelihood of timely reimbursement for non-surgical sialolithotomy procedures.