Is D7865 covered by dental insurance?

Coverage varies; check with the patient's insurance provider as TMJ procedures may be covered under medical benefits.

What are common symptoms indicating the need for arthroplasty?

Severe joint pain, dysfunction, and presence of osteophytes are common indicators for this procedure.

How does arthroplasty differ from other TMJ surgeries?

Arthroplasty specifically involves reshaping the joint to eliminate irregularities, unlike other surgeries that may focus on different aspects of joint repair.

Can arthroplasty be performed bilaterally?

Yes, arthroplasty can be performed on both joints if necessary, and appropriate billing modifiers should be used.

D7865

Arthroplasty - CDT Code Guide

Oral & Maxillofacial Surgery/Reduction of Dislocation and Management of Other Temporomandibular Joint Dysfunctions

Overview

CDT Code D7865 refers to the arthroplasty procedure, which involves the reduction of osseous components of the joint to create a pseudoarthrosis and eliminate irregular remodeling patterns, such as osteophytes. This procedure is typically performed to address temporomandibular joint (TMJ) dysfunctions, where the joint's normal function is impaired due to structural abnormalities. Arthroplasty aims to restore joint function and alleviate pain by reshaping the joint components. Dental professionals may encounter this procedure in patients experiencing severe TMJ disorders that do not respond to conservative treatments. It is often considered when there is significant joint degeneration or when other surgical interventions are not suitable.

When to Use This Code

Severe TMJ dysfunction with significant joint degeneration
Persistent pain and dysfunction not responsive to conservative treatments
Presence of osteophytes causing joint irregularities
Cases requiring joint reshaping to restore function
Patients with chronic TMJ dislocation issues

Documentation Requirements

Detailed patient history and examination findings
Radiographic evidence of joint degeneration or osteophytes
Clinical notes on previous treatments and their outcomes
Surgical plan outlining the arthroplasty procedure
Post-operative care instructions and follow-up plan
Patient consent forms for surgical intervention

Billing Considerations

When billing for D7865, ensure that the procedure is documented thoroughly, as insurance providers may require evidence of medical necessity. Frequency limitations may apply, and it is essential to check with the patient's insurance for coverage details. Common modifiers may include those indicating bilateral procedures or complications. Coordination with medical insurance may be necessary, as TMJ procedures sometimes fall under medical rather than dental benefits.

Related CDT Codes

D7810 D7850 D7880 D7899

Frequently Asked Questions

The primary goal is to restore normal joint function and alleviate pain by reshaping the joint components.

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