Oral Surgery Medical In Nature - Aetna Dental | …

1 Current Den tal Termin olo gy American De nt al A sso ciatio n. A ll rig h ts re s erv ed. 01/01/2018 Medical in Nature oral S urg ery 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, m us cl e; superficial Biopsy, bone, excisional; superficial Biopsy, bone, excisional; deep D7286 Biopsy of oral tissue (s oft) 20200 20205 40490 40808 41100 41105 41108 42100 42800 Biopsy, m us cl e; 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 s am ple 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 ( Liquid based slide preparation method), except cervical or vaginal Current Den tal Termin olo gy American De nt al A sso ciatio n.

2 A ll rig h ts re s erv ed. 01/01/2018 D7295 Harve s t 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 cm 21015 Radical resection of tumor ( , malignant neoplasm); s oft tissue of fac e or scalp D7411 Excision of benign lesion greater than cm 21030 21040 Excision of benign tum or or cyst of maxilla or zygoma by enucleation and curettage Excision of benign tum or 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 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.

3 25 cm 21034 21044 Excision of malignant tumor of maxilla or zygoma Excision of malignant tumor of mandible D7415 Excision of malignant lesion, complicated 21034 21044 21045 Excision of malignant tumor of maxilla or zygoma Excision of malignant tumor of mandible Excision of malignant tumor of mandible; radical resection Current Den tal Termin olo gy American De nt al A sso ciatio n. A ll rig h ts re s erv ed. 01/01/2018 D7440 Excision of malignant t um or lesion diameter up to 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 Excis ion of malignant t umor lesion diameter over 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 cm 21030 21040 41825 41826 41827 Excision of benign tum or or cyst of maxilla or zygoma by enucleation and curettage 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.

4 With complex repair Review when submitted in conjunction wit h removal of impacted teeth Current Den tal Termin olo gy American De nt al A sso ciatio n. A ll rig h ts re s erv ed. 01/01/2018 D7451 Removal of benign odontogenic cyst or tumor; lesion diameter greater than cm 21030 21040 41825 41826 41827 Excision of benign tum or or cyst of maxilla or zygoma by enucleation and curettage 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 Review when submitted in conjunction wit h removal of impacted teeth D7460 Removal of benign non-odontogenic cyst or tumor; lesion diameter up to cm 21030 21040 41825 41826 41827 Excision of benign tum or or cyst of maxilla or zygoma by enucleation and curettage Excision of benign cyst or tumor of mandible, by enucleation and/or curettage Excision of lesion or tumor, dentoalveolar structures.

5 Without repair Excision of lesion or tumor, dentoalveolar structures; with simple repair Excision of lesion or tumor, dentoalveolar structures; with complex repair Current Den tal Termin olo gy American De nt al A sso ciatio n. A ll rig h ts re s erv ed. 01/01/2018 D7461 Removal of benign non-odontogenic cyst or tumor; lesion diameter greater than cm 21030 21040 41825 41826 41827 Excision of benign tum or or cyst of maxilla or zygoma by enucleation and curettage 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 ( , 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 Current Den tal Termin olo gy American De nt al A sso ciatio n.

6 A ll rig h ts re s erv ed. 01/01/2018 D7510 Incision and drainage of abscess intraoral s oft tissue 20000 40800 41000 41005 41007 41008 41009 41800 42000 42310 Incision of s oft t i ss ue abscess ( , 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.

7 Submaxillary or sublingual, intraoral Current Den tal Termin olo gy American De nt al Associatio n. A ll rig h ts re s erv ed. 01/01/2015 D7511 Incision and drainage of abscess intraoral s oft tissue complicated (includes drainage of multiple fascial spaces) 20005 40801 41006 Incision of s oft 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 s oft 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 Extraoral incision and drainage of abscess, cyst or hematoma of floor of mouth; submental Extraoral incision and drainage of abscess, cyst or hematoma of floor of mouth.

8 Submandibular Extraoral incision and drainage of abscess, cyst or hematoma of floor of mouth; masticator space Drainage of abscess; parotis, simple Current Den tal Termin olo gy American De nt al Associatio n. A ll rig h ts re s erv ed. 01/01/2015 D7521 Incision and drainage of abscess extraoral s oft 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 ( , buried wire, pin, or rod) Removal of embedded foreign body, vestibule of mouth; simple Removal of embedded foreign body from dentoalveolar structures, s oft tissue D7540 Removal of reaction producing foreign bodies, musculoskeletal 20680 40805 41806 Removal of implant; deep ( , buried wire, pin, or rod) Removal of embedded foreign body, vestibule of mouth; simple Removal of embedded foreign body from dentoalveolar structures.

9 Bone D7550 Partial ostectomy/ sequestrectomy for removal of non-vi t a l bone 21025 Excision of bone, mandible ( , for osteomyelitis or bone abscess) X 41830 Alveolectomy, including curettage of osteitis or sequestrectomy Current Den tal Termin olo gy American De nt al Associatio n. A ll rig h ts re s erv ed. 01/01/2015 D7560 Maxillary sinusotomy for removal of tooth fragment or foreign body 31020 31030 Sinusotomy, maxilla ry (antrotomy); intranasal Radical (Caldwell-Luc) without removal of antrochoanal polyps D7610 Maxilla, simple fracture, open reduction, t eeth immobilized (if present) 21445 Open treatment of mandibular or maxillary alveolar ridge fracture D7620 Maxilla, simple fracture, closed reduction, t eeth immobilized (if present 21440 Closed treatment of mandibular or maxillary alveolar ridge fracture D7630 Mandible, s i m ple fracture, open reduction, teeth immobilized (if present) 21462 Open treatment of mandibular fracture: with interdental fixation D7640 Mandible, s i m ple 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.)

10 With interdental fixation D7650 Malar and/or zygomatic arch, simple fracture, open reduction 21356 21360 Open treatment of depressed zygomatic fracture ( , Gillies approach) Open treatment of depressed malar fracture, including zygomatic arch and malar tripod Current Den tal Termin olo gy American De nt al Associatio n. A ll rig h ts re s erv ed. 01/01/2015 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 s imple - Alveolus closed reduction, may include stabilization of teeth 21440 Closed treatment of mandibular or maxillary alveolar ridge fracture D7671 Fracture s imple - Alveolus open reduction, may include stabilization of teeth 21445 Open treatment of mandibular or maxillary alveolar ridge fracture D7680 Facial bones, simple fracture, complicated reduction with fixation and multiple surgical approaches 21432 21433 21435 Open treatment of craniofacial separation (LeForte III type).