If a patient has periocoronitis on tooth 17 and the dentist burns the flap of skin off, what is the correct code? I say D7971, but the dentist insists that I code it under D7280, since operculectomy is not covered under the patient’s insurance (Florida Medicaid). The dentist did not remove any bone, did not make an incision. Who is right?

The appropriate code to utilize with a patient that has a diagnosis of periocoronitis and has the pericornal gingiva excised or removed is D7971. Using an inappropriate code just because it pays is considered abusive and you may be audited and fined.

You may try billing the claim to the Medical carrier using 41821 and the diagnosis code of 523.11 as these are appropriate and may assist in reimbursement.