Definition of a Surgical Extraction

[MrRongeurs]

Different faculty have given us different definitions of surgical extraction and students at my school are clueless (a 4th year told me she didn't want me to lay a flap because it would make it surgical - increased cost to the pt...).

I was always under the impression that surgical extraction meant, either:
1) Sectioning the tooth (with or without surgical handpiece)
2) Removal of bone (with or without surgical handpiece)

Are there different definitions (AAMOS vs CDT Codes) for surgical extractions?

Thanks for all the help! Any resources would be greatly appreciated.

---

Members don't see this ad.

 

[tingting]

You are correct. There needs to be sectioning of the tooth and/or bone removal. I cant speak to the with/without surgical handpiece aspect because I always use one for a surgical ext.

Personally I always lay a flap on a surgical extraction, however it is not required for the code and is thus irrelevant.

 

[KinKs]

Good question - generally if I touch a hand piece or raise a flap (15 blade) I deem it surgical. I don't think just sectioning a tooth is a sufficient definition. # 23 will section a tooth sometimes and the extraction does not necessary become surgical.

 

[djeffreyt]

Check the dental code definition:

D7210
Surgical removal of erupted tooth requiring elevation of mucoperiosteal
flap and removal of bone and/or section of tooth

So by definition, there must be raising a flap AND removal of bone/tooth sectioning

So, if you raie a flap but don't remove bone or section the tooth, then it's not considered surgical
If you section the tooth but don't raise a flap, it's not considered surgical
etc.

In practice, people bill surgicals all the time even if they don't do both a flap and bone removal and sectioning. Some people like to say severing the PDL is raising a full thickness "flap" to make it fit the definition. Then they section the tooth and elevate the roots out. And, frankly, there is a lot to be said for experience. A lot of dentists who practice for long enough know how to get teeth out without flaps and bone removal, but an inexperienced dentist might have problems and need to remove bone and raise a flap. By definition, the inexperienced dentist did a surgical while the experienced one did a simple extraction, but it's unfair that the dentist who is just better at the procedure cannot be paid the same as the inexperienced dentist.

 

[DrTacoElf]

Surgical extraction has nothing to do with a flap. It is surgical if bone is removed or tooth is sectioned. End of story.

Soft tissue impaction has to do with a flap but not bone removal.

 

[bsp1013]

If I pick up a handpiece, it's surgical.

If I lay a flap, it's surgical. (but if I'm doing that, I'm going to remove bone, so kind of a moot point)

If I remove bone, it's surgical.

 

[Diezel69x]

If I pick up a handpiece, it's surgical.

If I lay a flap, it's surgical. (but if I'm doing that, I'm going to remove bone, so kind of a moot point)

If I remove bone, it's surgical.

Agreed 100%, but, a case where a tooth has a lot of bone loss on the x-ray and looks like a 2 second extraction but u break off a root tip, lay a flap and get it out do u bill as a surgical?

 

[HupHolland]

^ If I'm fishing for root tips, I bill surgical.

 

[marrkarnell]

To prepare the patient for surgical extraction, a local anesthetic is first applied to numb the tooth and surrounding area. Typically within 5 to 10 minutes the area will be completely numb, lasting between 2 to 3 hours. After numbness has been confirmed by the dentist, the extraction will begin by gaining access to the tooth. Usually this requires opening the gum tissue with a small incision to expose root or bone. With more difficult teeth, a sectioning technique is used to make removal easier. Once the tooth is removed, sutures may be required to close the extraction site.

 

[The Anhedonia]

To prepare the patient for surgical extraction, a local anesthetic is first applied to numb the tooth and surrounding area. Typically within 5 to 10 minutes the area will be completely numb, lasting between 2 to 3 hours. After numbness has been confirmed by the dentist, the extraction will begin by gaining access to the tooth. Usually this requires opening the gum tissue with a small incision to expose root or bone. With more difficult teeth, a sectioning technique is used to make removal easier. Once the tooth is removed, sutures may be required to close the extraction site.

wait, i thought it was doorknob + string = tooth extraction. wtf local ane..... what is that?

 

[sladkfjaslk]

Check the dental code definition:

D7210
Surgical removal of erupted tooth requiring elevation of mucoperiosteal
flap and removal of bone and/or section of tooth

So by definition, there must be raising a flap AND removal of bone/tooth sectioning

So, if you raie a flap but don't remove bone or section the tooth, then it's not considered surgical
If you section the tooth but don't raise a flap, it's not considered surgical
etc.

In practice, people bill surgicals all the time even if they don't do both a flap and bone removal and sectioning. Some people like to say severing the PDL is raising a full thickness "flap" to make it fit the definition. Then they section the tooth and elevate the roots out. And, frankly, there is a lot to be said for experience. A lot of dentists who practice for long enough know how to get teeth out without flaps and bone removal, but an inexperienced dentist might have problems and need to remove bone and raise a flap. By definition, the inexperienced dentist did a surgical while the experienced one did a simple extraction, but it's unfair that the dentist who is just better at the procedure cannot be paid the same as the inexperienced dentist.

You are actually incorrect about this. A surgical extraction (D7210) requires either sectioning of the tooth or bone removal, but not both. Contrary to what you stated, it does not require a flap. Think of it this way. A skilled surgeon can often section a molar and remove it without a flap, while a novice may require both the sectioning and the flap. Should the skilled surgeon receive less compensation for the same procedure? That is most likely why the CDT was changed in 2011-12 to read as follows:

D7210: Surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated.

 

[sl2obel2ts]

I use my handpiece quiet often when extracting broken down molars when simple is definitely possible. I just find it easier and more predictable with sectioning a tooth. I chart these cases as simple exts. am I wrong?

 

[niles19]

I thought they changed the def to not include a flap??

 

[sladkfjaslk]

I use my handpiece quiet often when extracting broken down molars when simple is definitely possible. I just find it easier and more predictable with sectioning a tooth. I chart these cases as simple exts. am I wrong?

You should be billing a D7210. You are doing the patient a service with your extra skill in sectioning the tooth and not damaging the alveolar bone.

 

[sladkfjaslk]

I thought they changed the def to not include a flap??

Read my explanation above. Think you missed the point of my resurrecting this thread.

 

[niles19]

Oh I see what you are saying & I agree....lots of times I quote surgical but end up charging simple cuz it came out that way......NOT to say that some people still charge surgical cuz they can & they bill to what the X-ray shows (oral surgery style) cuz what looks partial bony is not always what it seems once a small flap is done

 

[DaleDoback]

Oh I see what you are saying & I agree....lots of times I quote surgical but end up charging simple cuz it came out that way......NOT to say that some people still charge surgical cuz they can & they bill to what the X-ray shows (oral surgery style) cuz what looks partial bony is not always what it seems once a small flap is done

Can I ask what this means?

OP: It's a very simple answer. Take bone away or section tooth is surgical. Shouldn't require this many opinions.

 

[niles19]

What this means is simply what it meant.....you ALWAYS should quote out surgical cuz you never know what it will be....1) what looks simple can end up being a nightmare (been there done that)...2) you look like hero as you take it out simple & save the patient money = good internal referrals that will reward your skills.

 

[niles19]

I agree....section tooth or remove bone = surgical regardless if a flap is done.

 

[DaleDoback]

What this means is simply what it meant.....you ALWAYS should quote out surgical cuz you never know what it will be....1) what looks simple can end up being a nightmare (been there done that)...2) you look like hero as you take it out simple & save the patient money = good internal referrals that will reward your skills.

We disagree on this one. I treatment plan a bunch of simple extractions. I have been burned before too, but it doesn't scare me into upcoding every tooth.

 

[niles19]

It's not about being scared....haha...FAR from it but I just wish to hedge my bets fiscally just incase what looks simple becomes surgical & if not I look like a hero to the patient....NO patient likes to hear "ohhh man that's gonna cost you more. Sorry but I had to remove bone soooo now it's gonna cost ya"...just say'n

Do whatcha gotta do....we all have different views which why dentistry is so great

 

[DaleDoback]

It's not about being scared....haha...FAR from it but I just wish to hedge my bets fiscally just incase what looks simple becomes surgical & if not I look like a hero to the patient....NO patient likes to hear "ohhh man that's gonna cost you more. Sorry but I had to remove bone soooo now it's gonna cost ya"...just say'n

Do whatcha gotta do....we all have different views which why dentistry is so great

I love these discussions.

Do you also treatment plan a DO on #20 when doing a MOD on #19 because you might nick the tooth?

And I never charge a patient more if I treatment plan for simple and it becomes surgical. I figure it all balances itself out after I flick away bone with a periosteal to expose my complete bony maxillary third molar. Technically, it's surgical and a complete bony. God, I love my job.

 

[niles19]

Truth be told....its ALL about treatment planning & hedging your bets against the unknown cuz the unknown & treatment planning don't care about your skills, the amount of CE you've taken, the new CT scan gadget you've got, where you went to school & IF you think you're a hot shot that thinks he/she can take that K9 root tip out "simply" on a 65yo Hispanic man with a Hx of grinding.

And to answer your DO on #20 question....I treatment plan using sound evidence base dentistry, by comprehensive Tx-planning with findings that balance themselves via X-rays & oral findings that support/define medical necessity and not but what I'm sure you might do....plus I use high magnification & LED head lamps to insure that #20 is never nicked in the process....unless the unknown epileptics
Parkinson's disease patient decides to jolt, shift or jerk unexpectedly at the last second of my prep refinement & even then I'd still evaluate for possible enamelplasty vs a DO on #20 after I consulted the valued patient.

So simple vs surgical = do what you wish, follow the code guidelines & treat others as you would yourself in an ethical manner

 

[DaleDoback]

Truth be told....its ALL about treatment planning & hedging your bets against the unknown cuz the unknown & treatment planning don't care about your skills, the amount of CE you've taken, the new CT scan gadget you've got, where you went to school & IF you think you're a hot shot that thinks he/she can take that K9 root tip out "simply" on a 65yo Hispanic man with a Hx of grinding.

And to answer your DO on #20 question....I treatment plan using sound evidence base dentistry, by comprehensive Tx-planning with findings that balance themselves via X-rays & oral findings that support/define medical necessity and not but what I'm sure you might do....plus I use high magnification & LED head lamps to insure that #20 is never nicked in the process....unless the unknown epileptics
Parkinson's disease patient decides to jolt, shift or jerk unexpectedly at the last second of my prep refinement & even then I'd still evaluate for possible enamelplasty vs a DO on #20 after I consulted the valued patient.

So simple vs surgical = do what you wish, follow the code guidelines & treat others as you would yourself in an ethical manner

Haha. So you treatment plan based on evidence based dentistry with all those things........except for taking out teeth, then you treatment plan based on the unknown while hedging your bets. Are you a politician in your spare time?

I'm just messing with you. I know many surgeons who have never done a simple extraction because they are a surgeon. You're right, treat patients well and everything will be fine.

 

[sl2obel2ts]

this.

I love these discussions.

Do you also treatment plan a DO on #20 when doing a MOD on #19 because you might nick the tooth?

And I never charge a patient more if I treatment plan for simple and it becomes surgical. I figure it all balances itself out after I flick away bone with a periosteal to expose my complete bony maxillary third molar. Technically, it's surgical and a complete bony. God, I love my job.

Let's say a patient walks into my practice with a broken down mand molar for ext. it's not endo txed, just broken down. I know I can take it out in 5-10 min, but with a handpiece 2-5 minutes. I don't use a handpiece and charge this dude a simple ext fee, or I choose to use a handpiece, save time, see another patient with time left over or even take a break.

!!?!?!!??!