Coding Loose Bone Removal Post Extraction

Estela Vargas, CRDH, CEO Remote Sourcing

Some patients may experience discomfort after a tooth extraction due to loose bone fragments in the extraction site. When these fragments cause pain, a follow-up visit to remove the loose bone and provide wound care is often required. The examination may reveal exposed loose bone in the area of the extraction. Should there be a charge for removing the bone and wound care? Can you code and bill insurance for this procedure?

Is Loose Bone Removal Covered by Insurance?

In many cases, insurance companies consider loose bone removal as part of the initial tooth extraction procedure, falling under the extraction's global fee. Typically, additional charges for bone removal are only considered if the procedure is extensive or performed by a dentist in a different office from the original extraction. In other words, there usually isn’t any additional payment unless the dentist performing the sequestrectomy is not in the same dental office as the dentist who did the extraction.

Coding for Loose Bone Removal After Extraction

D7550 Partial Ostectomy/Sequestrectomy for removal of non-vital bone

D7550 is described as removing loose or sloughed-off dead bone caused by infection or reduced blood supply. The area surrounding it is healthy bone.

D7999 Unspecified oral surgery procedure, by report

If the procedure involves more than simply removing loose bone fragments and exceeds the description of D7550, consider using D7999. This is an unspecified oral surgery code that requires detailed documentation. When submitting this code:

• Include a clear narrative description of the procedure.
• Attach relevant photos or X-rays to strengthen your claim.
• Ensure documentation supports the need for more extensive treatment.

Some dental plan payers will “remap” D7550 to a D9110 Palliative (Emergency) Treatment of Dental Pain-Minor Procedure. This code is for reporting a minor procedure to alleviate acute pain or discomfort. It is a per visit code.

Note: some insurance companies may downgrade “remap” the code to palliative D9110, but you still charge your standard fee for the service of  D7550! The patient is responsible for the difference.

D9110 Palliative Treatment of Dental Pain-Minor Procedure

A clear and detailed narrative is necessary to report D9110 whenever it is used. Do not report definitive treatment on the same date as D9110 Palliative.

If the visit is for the simple removal of a small loose or denuded non-vital bone, consider the Palliative Code D9110 instead of D7550 and include a narrative.

Additional Code for Consideration

D9930 – Treatment of Complications (post-Surgical) Unusual Circumstances, By Report

The D9930 code reports complications from a surgical procedure under unusual circumstances. However, many insurance plans will disallow this code or downgrade it to D9110 if the follow-up occurs within 30 days of the original extraction. Be aware that:

• This code may not be reimbursed if the procedure is conducted in the same office as the initial extraction.
• Most plans consider a follow-up within thirty days part of the original surgery’s global fee.

Key Takeaways for Billing Loose Bone Removal Post-Extraction

• Use D7550 for simple removal of non-vital bone, if applicable.
• Consider D7999 if the procedure is more extensive than D7550’s description.
• Prepare for remapping to D9110 by some insurance providers; ensure the patient understands potential out-of-pocket costs.
• Document thoroughly with narratives and visuals to support claims, especially when using codes like D7999 or D9110.

Disclaimer: This blog is for informational purposes only and does not constitute financial, legal, or medical advice. Always consult with a qualified professional or licensed practitioner for specific advice related to coding, billing, or any other area of practice.