Hemisection

Hemisection is a surgical procedure in which a multi-rooted tooth, typically a mandibular molar, is divided and one root along with its corresponding crown section is removed while the other root and its associated tooth structure are retained. This procedure is indicated when one root is compromised by a vertical root fracture, severe periodontal bone loss, perforation, or resorptive defect, but the remaining root has adequate bone support and a favorable long-term prognosis. The retained root portion is then restored, often functioning as a premolar-shaped unit that can serve as an independent tooth or as an abutment for a fixed prosthesis.

The billing workflow for hemisection cases spans multiple CDT code categories and typically involves several appointments. Endodontic treatment of the root being retained is coded under the root canal series (D3310, D3320, or D3330 depending on tooth type and number of canals treated). The surgical removal of the condemned root is coded under D7251 for coronectomy or root removal of a fractured tooth. Some cases may also involve D4260 or D4261 for osseous surgery if the surrounding bone requires recontouring. The subsequent restorative phase, usually a crown, adds another billable procedure. Each of these codes must be submitted with appropriate documentation, and the sequence of treatment matters for insurance processing because some carriers require that the endodontic treatment be completed and confirmed successful before approving the restorative phase.

For revenue cycle teams, hemisection cases require careful treatment coordination and proactive financial planning. Because the procedure involves multiple phases billed across separate visits, there is a risk of losing track of unbilled phases or failing to follow up on pending authorizations. Practices should flag these cases in their practice management system to ensure that each phase is billed as it is completed. Pre-authorization for each phase is advisable, as carriers may question whether hemisection is a cost-effective alternative to extraction and implant placement. A well-documented case that demonstrates the retained root's viability, supported by radiographic evidence and periodontal measurements, strengthens the argument for coverage of this tooth-preserving approach.