D3426Apicoectomy - Molar (First Root)

What This Code Covers

D3426 covers apicoectomy - molar (first root). The surgeon accesses the root tip through the bone, removes the infected tissue, and places a retrograde filling to seal the canal. This is indicated when conventional retreatment is not feasible or has failed.

Billing Guide

Bill this code when:

• The procedure described by D3426 is performed and documented
• The clinical indication supports the procedure
• Documentation meets the payer's requirements for the service

Do not bill this code when:

• A different procedure was actually performed
• The procedure is included in another code being billed at the same visit
• Documentation does not support the medical necessity of the procedure
• The procedure is better described by D3410 (Apicoectomy - anterior)

Insurance and Denial Prevention

Key Payer Rules:

• Endodontic treatment is typically covered at 50-80% as a major service
• Some payers require pre-operative radiographs for approval
• Retreatment codes have different fee schedules than initial treatment
• Surgical endodontic procedures may require prior authorization

Common Denials and How to Respond:

• Not medically necessary - Submit radiographs showing the pathology and document the diagnosis and treatment rationale.
• Should be extraction - Provide documentation of why the tooth is restorable and worth saving.
• Bundled with final root canal - If this is an interim procedure, document separate dates of service and the clinical reason for staged treatment.