oral surgery medical in nature - aetna dental

Current Dental Terminology © American Dental Association. All rights reserved. 01/01/2018

Medical in Nature Oral Surgery Effective 01/01/2018

CDT Code Description (CDT code)

CPT Code Description (CPT Code)

Requires Precert / Review by OMFS PM

D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth

21140 Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)

D7285 Biopsy of oral tissue (hard)

20220 20240 20245

Biopsy, muscle; superficial

Biopsy, bone, excisional;

superficial Biopsy, bone, excisional;

deep

D7286 Biopsy of oral tissue (soft)

20200 20205 40490 40808 41100 41105 41108 42100 42800

Biopsy, muscle; superficial

Biopsy, muscle; deep Biopsy of lip Biopsy, vestibule of

mouth Biopsy of tongue,

anterior two-thirds Biopsy of tongue,

Posterior one-third Biopsy floor of mouth Biopsy of palate, uvula Biopsy of oropharynx

D7287 Cytology sample collection

88104 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation

X

D7288

Brush biopsy - transepithelial sample collection

88112 Cytopathology, selective cellular enhancement technique with interpretation (e.g. Liquid based slide preparation method), except cervical or vaginal


D7295 Harvest of bone for use in autogenous grafting procedures

21215, 21210 - includes obtaining the graft, in which case this code would not be covered 20900 - bone graft any donor area

D7296 Corticotomy - one to three teeth or tooth spaces, per quadrant

21198-52 Osteotomy, mandible, segmental;

X

D7297 Corticotomy – four or more teeth or tooth spaces, per quadrant

21206-52 Osteotomy, maxilla, segmental (eg, Wassmund or Schuchard)

X

D7410 Excision of benign lesion up to 1.25 cm

21015 Radical resection of tumor (e.g., malignant neoplasm); soft tissue of face or scalp

D7411 Excision of benign lesion greater than 1.25 cm

21030 21040

Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage

Excision of benign tumor

or cyst of mandible, by enucleation and curettage

D7412 Excision of benign lesion, complicated

41827 Excision of lesion or tumor, dentoalveolar structures, with complex repair

D7413 Excision of malignant lesion up to 1.25 cm

21034 21044

Excision of malignant tumor of maxilla or zygoma

Excision of malignant tumor of mandible

D7414 Excision of malignant lesion greater than 1.25 cm

21034 21044



D7415 Excision of malignant lesion, complicated

21034 21044 21045



Excision of malignant tumor of mandible; radical resection


D7440 Excision of malignant tumor – lesion diameter up to 1.25 cm

21034 Excision of malignant tumor of maxilla or zygoma

Excision of malignant

tumor of mandible; Excision of malignant

tumor of mandible; radical resection

21044 21045

D7441 Excision of malignant tumor – lesion diameter over 1.25 cm

21034 Excision of malignant tumor of maxilla or zygoma

21044 21045

Excision of malignant tumor of mandible;

Excision of malignant

tumor of mandible; radical resection

D7450 Removal of benign odontogenic cyst or tumor; lesion diameter up to 1.25 cm

21030 21040 41825 41826 41827


Excision of benign cyst

or tumor of mandible, by enucleation and/or curettage

Excision of lesion or

tumor, dentoalveolar structures; without repair


tumor, dentoalveolar structures; with simple repair


tumor, dentoalveolar structures; with complex repair

Review when submitted in conjunction with removal of impacted teeth


D7451 Removal of benign

odontogenic cyst or tumor; lesion diameter greater than 1.25 cm

21030 21040 41825 41826 41827










Review when submitted in conjunction with removal of impacted teeth

D7460 Removal of benign non-odontogenic cyst or tumor; lesion diameter up to 1.25 cm

21030 21040 41825 41826 41827











D7461 Removal of benign non-odontogenic cyst or tumor; lesion diameter greater than 1.25 cm

21030 21040 41825 41826 41827


Excision of benign cyst or tumor of mandible, by enucleation and/or curettage

Excision of lesion or tumor, dentoalveolar structures; without repair

Excision of lesion or tumor, dentoalveolar structures; with simple repair

Excision of lesion or tumor, dentoalveolar structures; with complex repair

D7465 Destruction of lesion(s) by physical or chemical methods – by report

40820 41850 42160

Destruction of lesion or scar of vestibule of mouth by physical methods

Destruction of lesion;

dentoalveolar structures

Destruction of lesion,

palate or uvula

D7480 (code deleted 2003)

Partial ostectomy (guttering or saucerization)

21025 Excision of bone, mandible (e.g., for osteomyelitis or bone abscess)

X

21026 Excision of bone, facial bones

D7490 Radical resection of mandible with bone graft

21045 Excision of malignant tumor of mandible, radical resection

X

21215 Graft, bone; mandible X


D7510 Incision and

drainage of abscess – intraoral soft tissue

20000 40800 41000 41005 41007 41008 41009 41800 42000 42310

Incision of soft tissue abscess (e.g., secondary to osteomyelitis); superficial

Drainage of abscess, cyst hematoma, vestibule of mouth; simple

Intraoral incision and drainage of abscess, cyst or hematoma of tongue or floor of mouth; lingual

Intraoral incision and drainage of abscess, cyst or hematoma of tongue or floor of mouth; sublingual, superficial

Intraoral incision and drainage of abscess, cyst or hematoma of tongue or floor of mouth; submental space

Intraoral incision and drainage of abscess, cyst or hematoma of tongue or floor of mouth; submandibular space

Intraoral incision and drainage of abscess, cyst or hematoma of tongue or floor of mouth; masticator space

Drainage of abscess, cyst, hematoma from dentoalveolar structures

Drainage of abscess of palate, uvula

Drainage of abscess; submaxillary or sublingual, intraoral


D7511

Incision and drainage of abscess – intraoral soft tissue – complicated (includes drainage of multiple fascial spaces)

20005 40801 41006

Incision of soft tissue abscess (secondary to osteomyelitis); deep or complicated

Drainage of abscess,

cyst hematoma, vestibule of mouth; complicated

Intraoral incision and

drainage of abscess, cyst or hematoma of tongue or floor of mouth: sublingual, deep, supramylohyoid

D7520 Incision and drainage of abscess – extraoral soft tissue

10180 41015 41016 41017 41018 42300

Incision and drainage, complex, postoperative wound infection

Extraoral incision and

drainage of abscess, cyst or hematoma of floor of mouth; sublingual


drainage of abscess, cyst or hematoma of floor of mouth; submental


drainage of abscess, cyst or hematoma of floor of mouth; submandibular


drainage of abscess, cyst or hematoma of floor of mouth; masticator space

Drainage of abscess;

parotis, simple


D7521

Incision and drainage of abscess – extraoral soft tissue – complicated (includes drainage of multiple fascial spaces)

42320 42305

Drainage of abscess; submaxillary external

Drainage of abscess;

parotid, parotid, complicated

D7530 Removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue

20670 40804 41805

Removal of implant; superficial (e.g., buried wire, pin, or rod)

Removal of embedded

foreign body, vestibule of mouth; simple

Removal of embedded

foreign body from dentoalveolar structures, soft tissue

D7540 Removal of reaction producing foreign bodies, musculoskeletal

20680 40805 41806

Removal of implant; deep (e.g., buried wire, pin, or rod)

Removal of embedded

foreign body, vestibule of mouth; simple

Removal of embedded

foreign body from dentoalveolar structures; bone

D7550 Partial ostectomy/ sequestrectomy for removal of non-vital bone

21025 Excision of bone, mandible (e.g., for osteomyelitis or bone abscess)

X

41830 Alveolectomy, including curettage of osteitis or sequestrectomy


D7560 Maxillary sinusotomy for removal of tooth fragment or foreign body

31020 31030

Sinusotomy, maxillary (antrotomy); intranasal

Radical (Caldwell-Luc)

without removal of antrochoanal polyps

D7610 Maxilla, simple fracture, open reduction, teeth immobilized (if present)

21445 Open treatment of mandibular or maxillary alveolar ridge fracture

D7620 Maxilla, simple fracture, closed reduction, teeth immobilized (if present

21440 Closed treatment of mandibular or maxillary alveolar ridge fracture

D7630 Mandible, simple fracture, open reduction, teeth immobilized (if present)

21462 Open treatment of mandibular fracture: with interdental fixation

D7640 Mandible, simple fracture, closed reduction, teeth immobilized (if present)

21450 21451 21453

Closed treatment of mandibular fracture; without manipulation

Closed treatment of

mandibular fracture; with manipulation

Closed treatment of

mandibular fracture; with interdental fixation

D7650 Malar and/or zygomatic arch, simple fracture, open reduction

21356 21360

Open treatment of depressed zygomatic fracture (e.g., Gillies approach)

Open treatment of

depressed malar fracture, including zygomatic arch and malar tripod


D7660 Malar and/or zygomatic arch, simple fracture, closed reduction

21355 Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation

D7670 Fracture – simple - Alveolus – closed reduction, may include stabilization of teeth


D7671 Fracture – simple - Alveolus – open reduction, may include stabilization of teeth


D7680 Facial bones, simple fracture, complicated reduction with fixation and multiple surgical approaches

21432 21433 21435

Open treatment of craniofacial separation (LeForte III type); with wiring and/or internal fixation

Open treatment of

craniofacial separation (LeForte III type) complicated (e.g., comminuted or involving cranial nerve foramina), multiple surgical approaches

Open treatment of

craniofacial separation (LeForte III type) complicated, utilizing internal and/or external fixation techniques (e.g., head cap, halo device, and/or intermaxillary fixation)

D7710 Maxilla, compound fracture, open reduction

21422 21423

Open treatment of palatal or maxillary fracture (Leforte 1 type) Open treatment of palatal or maxillary fracture (Leforte 1 type) complicated (comminuted), multiple approaches


D7720 Maxilla, compound fracture, closed reduction

21421 Closed treatment of palatal or maxillary fracture (Leforte 1 type), with interdental wire fixation or fixation of denture or splint

D7730 Mandible, compound fracture, open reduction

21461 21462 21465

Open treatment of mandibular fracture; without interdental fixation

Open treatment of

mandibular fracture; with interdental fixation

Open treatment of

mandibular condylar fracture

D7740 Mandible, compound fracture, closed reduction

21453 Closed treatment of mandibular fracture with interdental fixation

D7750 Malar and/or zygomatic arch, compound fracture, open reduction

21360 21365 21366

Open treatment of depressed malar fracture, including zygomatic arch and malar tripod

Open treatment of

complicated fracture(s) of malar area, etc.

Open treatment of

complicated fracture(s) of malar area, etc. with bone grafting (includes obtaining graft)


D7760 Malar and/or

zygomatic arch, compound fracture, closed reduction

21355 Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation

D7770 Fracture – compound - Alveolus - open reduction stabilization of teeth


D7771 Fracture – compound - Alveolus – closed reduction stabilization of teeth


D7780 Facial bones, compound fracture, complicated reduction with fixation and multiple surgical approaches

21346 21347 21348

Open treatment of nasomaxillary complex fracture (Leforte II); with wiring and/or local fixation

Open treatment of

nasomaxillary complex fracture (Leforte II); requiring multiple open approaches

Open treatment of

nasomaxillary complex fracture (Leforte II); with bone grafting

D7810 Open reduction of dislocation

21490 Open treatment of temporomandibular dislocation

X

D7820 Closed reduction of dislocation

21480 Closed treatment of temporomandibular dislocation; initial or subsequent

X

D7830 Manipulation under anesthesia

21485 Closed treatment of TMJ dislocation – complicated

X

D7840 Condylectomy (non-ortho related)

21050 Condylectomy, temporomandibular joint

X


D7850 Meniscectomy (non-ortho related)

21060 Meniscectomy, partial or complete, temporomandibular joint

X

D7852 Disc repair 21240 Arthroplasty, temporomandibular joint, with or without autograft

X

D7854 Synovectomy 21240 Arthroplasty, temporomandibular joint, with or without autograft

X

D7856 Myotomy 21240 Arthroplasty, temporomandibular joint, with or without autograft

X

D7858 Joint reconstruction 21242 21243 21247

Arthroplasty, temporomandibular joint, with allograft

Arthroplasty,

temporomandibular joint, with prosthetic joint replacement

Reconstruction of

mandibular condyle with bone and cartilage autografts

X

X

X

D7860 Arthrotomy 21010 Arthrotomy, temporomandibular joint

X

D7865 Arthroplasty 21240 Arthroplasty, temporomandibular joint, with or without autograft

X

D7870 Arthrocentesis 20605 Arthrocentesis--- intermediate joint, bursa or ganglion (e.g., temporomandibular joint, etc.)

X Effective 12/03/2013, pre-

cert no longer required

D7871 Non-arthroscopic lysis and lavage

20605 Arthrocentesis--- intermediate joint, bursa or ganglion (e.g., temporomandibular joint, etc.)

X

D7872 Arthroscopy – diagnosis, with or without biopsy

29800 Arthroscopy, temporomandibular joint, diagnostic

X

D7873 Arthroscopy – surgical: lysis and lavage of adhesions

29804 Arthroscopy, temporomandibular joint, surgical

X


D7874 Arthroscopy –

surgical: disc repositioning and stabilization


X

D7875 Arthroscopy – surgical: synovectomy


X

D7876 Arthroscopy – surgical: discectomy


X

D7877 Arthroscopy – surgical: debridement


X

D7910 Suture of recent small wounds up to 5 cm

12011 12013 40830 41250 41251 42180

Simple repair of superficial wounds of face, ears, eyelids, nose, lips, and/or mucous membranes 2.5 cm or less

Simple repair of

superficial wounds of face, ears, eyelids, nose, lips, and/or mucous membranes 2.7 – 5.0 cm

Closure of laceration,

vestibule of mouth, 2.5 cm or less

Repair of laceration

2.5.cm or less; floor of mouth and/or anterior 2/3 of tongue

Repair of laceration

2.5.cm or less; floor of mouth and/or posterior 1/3

of tongue Repair, laceration of

palate, up to 2 cm


D7911 Complicated sutures - up to 5 cm.

12051 12052 40831 42182

Layer closure of wounds of face, etc; 2.5 cm or less

Layer closure of wounds

of face, ears, etc. – 2.6 cm to 5.0 cm

Closure of laceration,

vestibule of mouth, over 2.5 cm or complex

Repair, laceration of

palate, over 2 cm or complex

D7912 Complicated sutures

12053 12054 12055 41252

Layer closure of wounds of face, ears, etc. –5.1 cm to 7.5 cm


of face, ears, etc. - 7.6 cm to 12.5 cm


of face, ears, etc. - 12.6 cm to 20.0 cm Repair of laceration of tongue, floor of mouth, over 2.6 cm or complex

D7920 Skin graft (identify defect covered, location and type of graft)

15350 Application of allograft, skin, 100 sq. cm or less

X

D7940 Osteoplasty for orthognathic deformities (non- ortho related)

21208 21209

Osteoplasty, facial bones, augmentation (autograft, allograft or prosthetic implant)

Osteoplasty, facial

bones, reduction

X

X


D7941 Osteotomy –

mandibular rami 21193 21195 21196 21199

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy w/o bone graft

Reconstruction of

mandibular rami and/or body, sagittal split; without internal rigid fixation

Reconstruction of

mandibular rami and/or body, sagittal split; with internal rigid fixation

Osteotomy, mandible,

segmental; with genioglossus advancement

X

X

X

X

D7943 Osteotomy – ramus, open with bone graft

21194 Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy With bone graft (includes obtaining graft)

X

D7944 Osteotomy – segmented or subapical, per sextant or quadrant

21198 21199 21206

Osteotomy, mandible, segmental

Osteotomy, mandible,

segmental with genioglossus advancement

Osteotomy, maxilla,

segmental (e.g., Wassmund or Schuchard)

X

X

X

D7945 Osteotomy – body of mandible

21198 Osteotomy, mandible, segmental

X


D7946 Leforte I (maxilla – total)

21141 21145

Reconstruction midface, Leforte I; single piece, segment moving in any direction w/out bone graft

Reconstruction midface,

Leforte I; single piece, segment moving in any direction requiring bone grafts

X

X

D7947 Lefort I (maxilla - segmented)

21142 21143 21146 21147

Reconstruction of midface, etc.—two pieces, segment moving in any direction, without bone graft

Reconstruction of

midface, etc three or more pieces, segment moving in any direction, without bone graft

Reconstruction of

midface, etc two pieces, segment moving in any direction, requiring bone grafts (includes obtaining grafts)

Reconstruction of

midface, etc three or more pieces, segment moving in any direction, requiring bone grafts includes obtaining grafts)

X

X

X

X


D7948 Lefort II or III - without bone graft

21150 Reconstruction midface, Leforte II; anterior intrusion

D7949 Lefort II or III - with bone graft

21151 21154 21159

Reconstruction midface, Leforte II— any direction requiring bone grafts (includes obtaining grafts)


Leforte III— any type, requiring bone grafts (includes obtaining grafts)


Leforte III--- with forehead advancement requiring bone grafts (includes obtaining grafts); without Leforte I

D7950 Osseous, osteoperiosteal, or cartilage graft of the mandible or facial bones – autogenous or nonautogenous, by report

21210 21215

Graft, bone, nasal, maxillary or malar areas (includes obtaining graft)

Graft, bone, mandible

(includes obtaining graft

X

X

D7951 Sinus agumentation with bone or bone substitutes via a lateral open approach

21210 Graft, bone, nasal, maxillary or molar areas (includes obtaining graft)

X

D7952 Sinus 21216 21210

Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard) Graft, bone, nasal, maxillary or molar areas (includes obtaining graft)

X

X


D7955 Repair of maxillofacial soft & hard tissue defects

21208 21270

Osteoplasty, facial bones, augmentation (autograft, allograft or prosthetic implant)

Malar augmentation,

prosthetic material

X

X

D7980 Sialolithotomy 42330 42335 42340

Sialolithotomy, submandibular, sublingual, or parotid, uncomplicated intraoral

Sialolithotomy,

submandibular, complicated; intraoral

Sialolithotomy, parotid,

extraoral or complicated intraoral

D7981 Excision of salivary gland

42410 42415 42420 42425 42440

Excision of parotid tumor or parotid gland; lateral lobe, w/o nerve dissection

Excision of parotid tumor

or parotid gland; lateral lobe, with dissection and preservation of facial nerve


or parotid gland; total, with dissection and preservation of facial nerve


or parotid gland; total, en block removal with sacrifice of facial nerve

Excision of

submandibular gland


42450

42507 42508 42509

Excision of sublingual gland

Parotid duct diversion,

bilateral (Wilke type procedure);

Parotid duct diversion,

bilateral with excision of one submandibular gland

Parotid duct diversion, bilateral with excision of both submandibular glands

D7982 Sialodochoplasty 42500 42505

Plastic repair of salivary duct, sialodochoplasty. Primary or simple Plastic repair of salivary duct, sialodochoplasty. secondary or complicated

D7983 Closure of salivary fistula

42600 Closure of salivary fistula

D7990 Emergency tracheotomy

31603 31605

Tracheostomy, emergency procedure; transtracheal Tracheostomy, emergency procedure; cricothyroid membrane

D7991 Coronoidectomy 21070 Coronoidectomy X

D7995 Synthetic graft – mandible or facial bones, by report

21125 Augmentation, mandibular body or angle; prosthetic material

X

D7996 Implant-mandible for augmentation purposes

21120 21127

Genioplasty, augmentation (autograft, allograft or prosthetic material) Augmentation, mandibular body or angle, with bone graft, onlay or interpositional

X

X


D7997 Appliance removal (not by the dentist who placed appl.)

20670 21046 21047 21048 21049

Removal of implant, superficial (e.g., buried wire, pin or rod) Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy {e.g., locally aggressive or destructive lesion (s)} Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy {e.g., locally aggressive or destructive lesion (s)} Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy {e.g., locally aggressive or destructive lesion (s)} Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy {e.g., locally aggressive or destructive lesion (s)}

X

X (only if billed along with

any extraction)

X

X

X

oral surgery medical in nature - aetna dental

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