Understanding Dental Code D7980

When to Use D7980 dental code

The D7980 dental code refers to a surgical sialolithotomy, which is the removal of a salivary stone from the duct or gland. This CDT code should be used when a patient presents with symptoms such as swelling, pain, or infection due to a sialolith (salivary stone) that requires surgical intervention. It is important to differentiate this code from other oral surgery codes, such as those for soft tissue excisions or other gland procedures, to ensure accurate billing and clinical reporting.

Documentation and Clinical Scenarios

Proper documentation is critical when billing for D7980. The clinical record should include:

• A detailed patient history, including symptoms and duration
• Diagnostic findings (e.g., radiographs or imaging confirming the presence and location of the sialolith)
• A description of the surgical procedure performed, including anesthesia used and the method of stone removal
• Post-operative instructions and follow-up care plan

Common clinical scenarios for D7980 include patients with recurrent swelling of the submandibular or parotid gland, confirmed obstruction by imaging, and failed conservative management (such as massage or sialogogues). In these cases, surgical removal is medically necessary and should be clearly justified in the clinical notes.

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D7980:

• Verify benefits before treatment to determine if the patient’s dental or medical plan covers surgical sialolithotomy. Some plans may consider this a medical procedure.
• Submit comprehensive documentation with the claim, including clinical notes, radiographs, and a narrative explaining the necessity of the procedure.
• Use the correct CDT code (D7980) and avoid code stacking with other oral surgery codes unless multiple distinct procedures were performed. If another procedure is performed, such as a biopsy (biopsy code), document each service separately.
• Review the Explanation of Benefits (EOB) carefully. If denied, check for missing documentation or request a peer-to-peer review if medical necessity is questioned.
• Appeal denied claims promptly with additional supporting documentation, such as specialist referrals or imaging reports.

Example Case for D7980

Case Example: A 45-year-old patient presents with intermittent swelling under the jaw, especially during meals. Panoramic radiograph reveals a 6mm radiopaque mass in the submandibular duct. Conservative measures fail, and the dentist performs a surgical sialolithotomy under local anesthesia, successfully removing the stone. The clinical notes detail the findings, procedure, and follow-up care. The dental office submits a claim with D7980, attaches the radiograph, and includes a narrative describing the patient’s symptoms and failed conservative treatment. The claim is approved, and payment is received without delay.

This example highlights the importance of thorough documentation, correct code selection, and proactive communication with payers to ensure successful reimbursement for D7980 procedures.