We see a lot of confusion surrounding CDT code D7111 as it relates to the extraction of a primary tooth. Keeping up with CDT codes is always a challenge for dental professionals, but this knowledge is crucial for proper claim submission that will lead to timely reimbursement from insurance companies.
Dental ClaimSupport is a trust dental billing partner that works to get dental teams paid by insurance. Through 10+ years of this work, we've seen the specific CDT codes that dental teams struggle with. That's why we've developed Dental Claims Academy as well - to help dental teams keep up with the ever-changing nature of dental insurance.
In this article, we'll explain how to correctly code the extraction of a primary tooth, and where CDT code D7111 fits in. Extraction of deciduous or primary teeth are documented with one of two CDT codes. The proper code selection depends on whether the primary tooth extracted includes the roots or whether it is just a coronal remnant.
Let's dive in.
What is the coronal remnant of a primary tooth?
When it is time for a primary tooth to be lost to make room for the eruption of a permanent successor tooth, the primary tooth begins to be naturally resorbed by the body. This resorption process begins at the tooth roots.
Once the tooth roots are reabsorbed back into the body, only the crown of the tooth remains. This is the coronal remnant of the tooth. The coronal remnant of the primary tooth is retained in the mouth by soft tissue only.
Not all children or parents can remove a primary tooth for various reasons. Therefore, the tooth may be removed by the dentist. When removing a coronal remnant, report CDT code D7111. The code is defined below.
Code D7111 does not apply to the removal of all primary teeth as defined by the nomenclature. The nomenclature language stating “coronal remnants” is often overlooked and it is assumed that D7111 is to be used for all primary teeth but that is not the case.
Code D7111 also includes a descriptor that further clarifies the intent of the code. The descriptor language of “soft tissue-retained” further clarifies that the code describes a primary tooth retained only by soft tissue, no roots.
So, how do you code for the removal of a primary tooth retained by remaining roots?
The removal of a primary tooth retained by roots is appropriately documented and reported using code D7140.
D7140extraction, erupted tooth or exposed root (elevation and/or forceps
Includes removal of tooth structure, minor smoothing of socket bone, and closure, as necessary.
Code D7140 is not specific to a permanent or primary tooth extraction. Therefore, it is appropriate to document the extraction of a primary tooth retained by tooth roots using D7140.
How much should I charge for primary tooth extractions?
Some practices struggle with what fee to charge for the removal of a root retained primary tooth. Usually, this is a simple procedure that does not require a lot of the doctor’s time.
Also, you may not elect to charge the same fee for the extraction of a primary tooth with roots as you would for the extraction of a permanent tooth, which can take much longer to perform and be more difficult.
When electing to charge a different fee for D7140, it is allowed to have different fees for the same procedure code. That is, as long as you treat all patients similarly in similar circumstances.
Meaning that you can have a standard fee of $50 for all permanent tooth extractions and a $25 standard fee for primary tooth extractions as long as you routinely charge $50 for permanent teeth and $25 for primary teeth. Be consistent.
How are different fees for the same procedure code entered into your software?
Using our example of D7140, enter D7140A as the office code with the fee of $50 for permanent teeth and D7140B as the office code with the fee of $25 for primary teeth.
The code reported on the claim will be D7140 but by using the selected code of D7140A or D7140B, the appropriate fee will be documented on the ledger and reported on the claim. Software instructions on how to enter different fees for the same CDT code may vary, reach out to your software support team as to how best to do this.
If you are in-network with the payer, always report the actual fee charged for the service, never the contracted fee. So, if you perform the removal of a primary tooth retained by roots, using our example above, report $25 as the actual fee charged on the line item of the claim form.
If the plan pays 100% of the contracted fee, say $80 for D7140; the plan will pay $25, not $80. Reporting the actual fee charged ensures accurate reporting and that you are not over-billing the insurance plan.
Ready to code with confidence at your dental practice?
You now can confidently code for the extraction of a primary tooth. Education in coding and documentation is crucial for all dental practices. Not only for reimbursement but for compliance purposes. Your dental team's goals should always include remaining profitable while also remaining legal and compliant. This will lead to further success.
Invest in your team’s coding and administrative education by participating in our Dental Claims Academy webinars. You can even earn CE credits. Learn the full nomenclature and descriptor of dental codes with other dental professionals.