Is pre-authorization required for D7260?

Pre-authorization may be required by some insurance providers. It's important to verify with the specific insurer before proceeding.

Can D7260 be billed with other surgical codes?

Yes, D7260 can be billed alongside other surgical codes if multiple procedures are performed, but ensure proper documentation and use of modifiers.

What are common complications of an untreated oroantral fistula?

Untreated oroantral fistulas can lead to chronic sinusitis, recurrent infections, and difficulty in oral function.

How long is the recovery period after an oroantral fistula closure?

Recovery time can vary, but patients typically require a few weeks for complete healing, with follow-up appointments to monitor progress.

D7260

Oroantral Fistula Closure - CDT Code Guide

Oral & Maxillofacial Surgery/Other Surgical Procedures

Overview

CDT Code D7260 refers to the surgical procedure for closing an oroantral fistula, which is a pathological connection between the maxillary sinus and the oral cavity. This procedure involves the excision of the fistulous tract and closure using an advancement flap. It is typically performed by oral and maxillofacial surgeons to prevent complications such as chronic sinusitis or infection. The procedure is crucial when a fistula forms following dental extractions or trauma, ensuring proper healing and function of the sinus and oral cavity.

When to Use This Code

When a patient presents with a fistula between the maxillary sinus and oral cavity post-extraction.
In cases of chronic sinusitis attributed to an oroantral fistula.
Following trauma that results in a communication between the oral cavity and sinus.
To prevent recurrent infections in patients with a persistent oroantral fistula.
When conservative management of an oroantral fistula has failed.

Documentation Requirements

Detailed patient history and clinical examination notes.
Radiographic evidence supporting the presence of an oroantral fistula.
Surgical notes detailing the procedure performed, including the use of an advancement flap.
Post-operative care instructions and follow-up plan.
Consent forms signed by the patient acknowledging understanding of the procedure.

Billing Considerations

Ensure accurate documentation of the procedure to justify the use of D7260. Check for any frequency limitations imposed by the patient's insurance. Common modifiers include those indicating bilateral procedures or complications. Verify coverage with the patient's insurance provider, as some may require pre-authorization.

Related CDT Codes

D7250 D7280 D7310 D7320

Frequently Asked Questions

An oroantral fistula is an abnormal connection between the oral cavity and the maxillary sinus, often resulting from dental extractions or trauma.

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