Understanding Dental Code D7991

When to Use D7991 dental code

The D7991 dental code is designated for a coronoidectomy, which is the surgical removal of the coronoid process of the mandible. This procedure is typically performed to address restricted mandibular movement, often due to trauma, tumor, or congenital conditions. Dental practices should use D7991 when the coronoidectomy is medically necessary and not part of a broader procedure, such as a mandibular resection or temporomandibular joint (TMJ) surgery, which have their own specific CDT codes. Proper code selection is crucial for accurate billing and insurance reimbursement.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing D7991. Clinical notes should clearly state the diagnosis (e.g., trismus due to coronoid hyperplasia or fibrosis), the medical necessity for the procedure, and any conservative treatments attempted prior to surgery. Include preoperative imaging, intraoperative findings, and postoperative care plans. Common clinical scenarios include:

• Limited jaw opening unresponsive to physical therapy
• Coronoid process impingement identified on radiographs or CBCT
• Adjunctive treatment for oral submucous fibrosis

Always ensure that the documentation supports the use of D7991 and is easily accessible for claim submission or potential audits.

Insurance Billing Tips

Successfully billing for D7991 requires a proactive approach to insurance verification and claim submission. Here are best practices:

• Pre-authorization: Contact the patient’s dental and medical insurance to determine if pre-authorization is required. Submit clinical notes, radiographs, and a detailed narrative explaining the necessity of the coronoidectomy.
• Cross-coding: Since D7991 may be considered a medical procedure, be prepared to submit claims to both dental and medical payers. Use the appropriate ICD-10 diagnosis codes and, if needed, the corresponding CPT code for coronoidectomy.
• Claim submission: Attach all supporting documentation, including pre-op and post-op images, to minimize delays. Clearly indicate D7991 on the claim form and double-check for coding accuracy.
• Appeals: If the claim is denied, review the EOB for denial reasons, gather additional supporting documentation, and submit a timely appeal with a detailed letter of medical necessity.

Following these steps helps reduce accounts receivable (AR) days and maximizes reimbursement for surgical procedures.

Example Case for D7991

Consider a patient presenting with chronic trismus and pain on opening. Imaging reveals bilateral coronoid hyperplasia impinging on the zygomatic arch. Conservative management, including physical therapy and anti-inflammatory medications, fails to improve symptoms. The oral surgeon documents the findings and recommends a bilateral coronoidectomy. The dental office verifies benefits, obtains pre-authorization, and submits a claim with D7991, attaching all clinical records and imaging. The claim is approved, and payment is received without delay, demonstrating the importance of thorough documentation and proactive insurance workflows.