How to Properly Use Dental Code D7240 When Submitting Insurance Claims

Dental code D7240 refers to the removal of an impacted tooth – completely bony. This code is used when a tooth, typically a wisdom tooth, is fully encased in bone and requires a surgical procedure for extraction. Proper documentation and claim submission are essential to ensure timely reimbursement and minimize denials from insurance companies. Below is a guide on how to correctly use D7240 when submitting claims.

Understanding D7240: What It Covers

D7240 is used for surgical extractions where:

• The tooth is completely covered by bone (as verified by radiographs).

• The procedure requires bone removal and/or sectioning of the tooth.

• There is soft tissue reflection and bone access beyond a simple extraction.

• It is performed by a general dentist or oral surgeon under local or general anesthesia.

Key Documentation for Successful Claims

To prevent denials and ensure smooth processing, include the following documentation:

1. Pre-Operative Diagnostic Records

• Radiographs (Panoramic or CBCT Scan): Must clearly show the impacted tooth and its full bony impaction.

• Clinical Notes: Justification for extraction, such as pain, swelling, decay, or infection risk.

• Periodontal Charting (if applicable): Supporting evidence for bone involvement.

2. Detailed Procedure Notes

• Description of bone removal and method used.

• Sedation or anesthesia type administered.

• Any complications or additional procedures performed during extraction.

3. Insurance Claim Submission Best Practices

• Use the correct tooth number and quadrant.

• Ensure the diagnosis code (ICD-10) matches the claim (e.g., K01.1 for impacted teeth).

• Submit with a narrative if the insurance company requires further explanation.

• Indicate whether it is medically necessary (some cases may require submission to medical insurance first).

Common Reasons for Denial & How to Avoid Them

1. Lack of Sufficient Documentation

   • Always include radiographs and clinical notes to justify the necessity of the procedure.

2. Incorrect Coding

   • Ensure the correct CDT and ICD-10 codes are used.

3. Missing Tooth Number or Quadrant

   • Double-check that the specific tooth is clearly identified.

4. Submitting to the Wrong Insurance

   • Some policies require submission to medical insurance first before dental insurance.

Final Tips for Successful Claim Approval

• Train staff on proper coding and documentation requirements.

• Review insurance policy exclusions before treatment.

• Appeal denied claims with additional supporting documentation if necessary.

• Utilize electronic claims submission for faster processing.

By following these guidelines, dental practices can ensure proper use of D7240, reduce claim denials, and improve reimbursement success rates. Proper coding and documentation not only support financial health but also ensure patients receive the benefits they deserve.