Billing for Oral and Maxillofacial Surgery: A Comprehensive Guide for Dental Coders
Published by the American Dental Coders Association
Introduction
Oral and maxillofacial surgery (OMS) is one of the most complex and highly regulated areas in dental billing. These procedures often straddle the line between medical and dental coverage, involve surgical coding nuances, and frequently require pre-authorization. Proper billing and documentation are critical for ensuring full reimbursement, avoiding denials, and maintaining compliance with both dental and medical payers.
In this post, we’ll explore best practices for coding, documentation, and claim submission when billing for oral and maxillofacial surgical services in a dental setting.
1. Understanding the Scope of OMS Billing
Oral and maxillofacial surgery includes procedures such as:
- Extractions (including impacted teeth)
- Treatment of facial trauma (e.g., fractures)
- Orthognathic surgery (jaw correction)
- Bone grafts and implant site preparation
- Cyst and tumor removal
- TMJ surgery
- Biopsies and reconstructive surgeries
Many of these services can be billed under CDT codes, but depending on the patient’s insurance, cross-coding to CPT/ICD-10 may be required.
2. CDT Codes Commonly Used in OMS
Key CDT codes include:
- D7140 – Extraction, erupted tooth or exposed root
- D7210 – Surgical removal of erupted tooth requiring elevation and removal of bone
- D7220–D7241 – Removal of impacted tooth (varies by complexity)
- D7280 – Surgical access of an unerupted tooth
- D7450 – Removal of benign odontogenic cyst or tumor
- D7953 – Bone replacement graft for ridge preservation
- D7921 – Collection and application of autologous blood concentrate
Always ensure you are using the latest CDT code updates, and check payer policies for coverage specifics.
3. When Medical Billing is Necessary
If the procedure is medically necessary (e.g., due to trauma or pathology), it may be reimbursable under the patient’s medical insurance. Examples include:
- Jaw fracture treatment
- TMJ surgery
- Biopsy for suspected malignancy
- Congenital deformity corrections
In such cases:
- Use CPT codes to describe the procedure (e.g., 21462 for open treatment of mandibular fracture)
- Include relevant ICD-10 diagnosis codes (e.g., S02.6XXA – Fracture of mandible)
- Ensure proper documentation and referral records
4. Pre-Authorization and Documentation
OMS procedures frequently require pre-authorization, especially if billed medically.
Best practices:
- Include narratives detailing medical necessity
- Attach clinical notes, radiographs, and referral letters
- Document anesthesia usage if billed separately (e.g., D9222 – deep sedation/first 15 minutes)
Clear and comprehensive documentation is essential to support the billed services and prevent denials.
5. Anesthesia and Surgical Aids
Many OMS procedures involve sedation or general anesthesia. Billing for anesthesia must align with time-based coding:
- D9222 – Deep sedation/general anesthesia – first 15 minutes
- D9223 – Each subsequent 15-minute increment
Other adjunctive services may include surgical stents, wound dressings, or graft materials. These are often billed separately and require supporting documentation.
6. Common Billing Pitfalls to Avoid
- Incorrect code selection – especially between simple and surgical extractions
- Missing medical cross-codes – when billing medical plans
- Failure to link diagnosis and procedure codes accurately
- Submitting incomplete documentation
- Not verifying coordination of benefits between dental and medical plans
Avoiding these mistakes helps reduce claim rejections and shortens reimbursement cycles.
7. Training and Certification Opportunities
Given the complexity of OMS billing, continuous education is key. The American Dental Coders Association offers specialized training to help coders master both dental and medical aspects of surgical billing.
Enroll in our:
These programs include real-world exercises, cross-coding techniques, and documentation tips specific to surgical procedures.
Conclusion
Billing for oral and maxillofacial surgery demands precision, up-to-date knowledge, and attention to payer requirements. From choosing the correct CDT or CPT codes to ensuring documentation supports medical necessity, the financial success of these cases hinges on the skill of the billing team.
Stay compliant and maximize reimbursement with advanced training from the American Dental Coders Association. Our certifications are designed to help you succeed in the evolving world of dental surgical billing.
