How to correctly code an intentional coronectomy

Coding for a coronectomy can confuse dentists and insurance coordinators and lead to claim denials. Though the code for an intentional partial tooth removal has been in the Code on Dental Procedures and Nomenclature (CDT) code set since about 2011, it often isn't used correctly to distinguish between intentional versus unintentional removal of tooth structure.

D7251: Coronectomy -- intentional partial tooth removal

Estela Vargas.

Code 7251 refers to an intentional partial tooth removal that is performed when a neurovascular complication is likely if the entire impacted tooth is removed. The key word here is "intentional," meaning the removal of part of the tooth (e.g., the impacted tooth crown) is done as planned.

The code language for D7251 reports a procedure where the coronal portion of the impacted tooth is removed and some residual tooth structure is intentionally left in the bone. Residual tooth structures are not disturbed but are intentionally left intact because removal may compromise or elicit a neurovascular complication (e.g., nerve damage).

A narrative of clinical notation is required when submitting this specific claim for payment to plan payers. The narrative/clinical notes should describe that a neurovascular complication (e.g., the tooth's close proximity to the neurovascular bundle) is likely if the entire impacted tooth is removed. A recent diagnostic quality radiograph or other images and clinical notes are necessary for proper documentation.

Note that code D7251 should have the pretreatment consent of the patient. The patient must be informed and consent to a partial extraction, leaving the residual tooth structure in place. Informed consent is standard procedure, but the patient must understand that some of the tooth will be left behind.

Before this code was added to the code set, a coronectomy was reported using extraction codes, such as D7230 or D7240, depending on how much of the crown was covered by bone.

Alternative codes

41899: Unlisted procedure, dentoalveolar structures

Importantly, code D7251 does not have a direct cross-code for medical claims. Record the dental coronectomy CDT code on the medical claim or try the Current Procedure Terminology (CPT) code 41899 and include a narrative/clinical report describing the procedure.

Please note that code 41899 is seldom successful. Better results are gained using dental extraction codes. When using 41899, it is recommended that you include the tooth number in the note box above the procedure line on the U.S. Centers for Medicare and Medicaid Services' (CMS) Health Insurance Claim Form CMS 1500.

D3921: Decoronation or submergence of an erupted tooth

Code D3921 refers to the intentional removal of coronal tooth structure to preserve the root and surrounding bone. Some specialists will intentionally decoronate a tooth to retain the bone width and height for future implant placement. The code does not specify that the tooth must be impacted.

D7999: Unspecified oral surgery procedure, by report

Code D7999 should be reported when there is an unintended partial extraction of a tooth and the patient is referred to an oral surgeon for removal of the remaining root fragment.

D7230: Removal of an impacted tooth -- partially bony

This code covers extraction when part of a tooth's crown is covered by bone and requires a mucoperiosteal flap elevation and bone removal to extract the tooth entirely. Please refer to CDT 2022 coding resources from the ADA for the complete description of this code, D7240, and other relevant CDT extraction codes.

D7240: Removal of an impacted tooth -- completely bony

Most crowns are covered by bone and require a mucoperiosteal flap elevation and bone removal.

A word of caution

Many payers may require dentists using codes D7251, D7230, D7240, and D3921 to submit the claim to medical insurance first. If medical insurance consideration is needed, you must attach the medical explanation of benefits to any further claims that are submitted.

Remember to code what you do. The clinical chart notes for procedures performed must match the appropriate CDT code. The supporting documentation must be of diagnostic quality and support the services rendered.

Estela Vargas, CRDH, is the founder and CEO of Remote Sourcing, a dental insurance billing and revenue recovery service. She is a graduate of Miami Dade College's dental hygiene program. Vargas' extensive background in the clinical arena of dentistry is coupled with her experience as a practice administrator and business executive.

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