Is pre-authorization required for D7461?

Pre-authorization requirements vary by insurance provider; check with the patient's insurer.

Can D7461 be billed with other surgical codes?

Yes, but ensure each procedure is documented separately and justified clinically.

What are common complications of this procedure?

Complications may include infection, bleeding, or nerve damage, though these are rare.

How should the lesion size be documented?

Document the lesion size using imaging or intraoperative measurements, clearly noting it exceeds 1.25 cm.

D7461

Removal of Benign Cyst >1.25 cm - CDT Code Guide

Oral & Maxillofacial Surgery/Excision of Intra-Osseous Lesions

Overview

CDT code D7461 pertains to the surgical removal of benign nonodontogenic cysts or tumor lesions with a diameter greater than 1.25 cm. This procedure is typically performed by an oral and maxillofacial surgeon and involves excising the lesion from the jawbone or surrounding oral structures. It is crucial for preventing potential complications such as infection, pain, or interference with oral function. Patients who have been diagnosed with such lesions through imaging or clinical examination may require this procedure to ensure oral health and function are maintained.

When to Use This Code

When a patient presents with a benign cyst or tumor larger than 1.25 cm in diameter.
Following imaging studies that confirm the presence of a nonodontogenic lesion exceeding 1.25 cm.
In cases where the lesion causes discomfort or impedes normal oral function.
When there is a risk of the lesion becoming infected or causing structural damage.
As part of a treatment plan for patients with multiple or recurring oral lesions.

Documentation Requirements

Detailed clinical notes describing the lesion and its size.
Radiographic evidence supporting the diagnosis and need for removal.
Pre-operative and post-operative photographs if applicable.
Pathology report confirming the benign nature of the lesion.
Patient consent forms acknowledging understanding of the procedure and risks.

Billing Considerations

Ensure accurate measurement documentation of the lesion to justify the use of this code. Be aware of any insurance-specific pre-authorization requirements. Consider using modifiers for bilateral procedures or when performed in conjunction with other surgeries. Frequency limitations may apply based on the patient's insurance policy.

Related CDT Codes

D7460 D7450 D7451 D7471 D7472

Frequently Asked Questions

D7460 is used for lesions 1.25 cm or smaller, while D7461 is for lesions greater than 1.25 cm.

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