When is D3473 used?
The D3473 dental code applies to surgical repair of root resorption in molar teeth. This CDT code is utilized when patients have internal or external root resorption requiring surgical treatment, specifically for molars. The code does not apply to non-surgical treatments or teeth other than molars. Proper code selection ensures appropriate reimbursement and prevents claim rejections.
D3473 Charting and Clinical Use
Complete documentation is vital when submitting claims for D3473. Clinical records must clearly outline the resorption's scope and position, the affected tooth (including tooth number), and detailed surgical procedures completed. Radiographic proof (like periapical or CBCT scans) should be maintained in patient files and provided with claims whenever feasible. Typical clinical situations include:
Extensive external resorption from trauma or orthodontic forces affecting molars
Internal resorption discovered during endodontic assessment requiring surgical intervention and repair
Situations where root damage threatens tooth stability and cannot be treated non-surgically
Ensure the clinical justification for surgery is thoroughly documented and that other treatment options have been evaluated or tried when suitable.
Billing and Insurance Considerations
To optimize reimbursement and reduce processing delays, apply these recommended practices when billing D3473:
Confirm benefits: Review the patient's dental insurance plan for surgical endodontic procedure coverage, as certain plans may have limitations or waiting requirements.
Prior approval: File a prior authorization request including comprehensive clinical documentation and radiographs to verify coverage before scheduling the procedure.
Proper coding: Apply D3473 exclusively for molars and confirm the procedure details align with the code. For procedures on premolars or anterior teeth, reference the correct code (see D3471 for anterior teeth or D3472 for premolars).
Include supporting materials: Provide clinical documentation, radiographs, and a written explanation detailing why surgical repair was necessary.
Monitor EOBs and follow through: Review Explanation of Benefits statements for payment status or denial explanations, and prepare to file appeals with additional evidence when required.
How dental practices use D3473
A 45-year-old patient reports discomfort and looseness in the mandibular right first molar. X-rays show significant external root resorption presumably from prior injury. Non-surgical endodontic treatment is considered inadequate given the defect's severity. The dentist completes surgical repair, eliminating resorptive material and reconstructing the root anatomy. Records include before and after radiographs, comprehensive narrative, and procedure documentation. The claim is filed using D3473, with insurance pre-approval secured before treatment, leading to timely payment.
Following these guidelines and keeping detailed records helps dental offices ensure proper billing and maximize reimbursement for surgical repair of root resorption in molars using the D3473 dental code.
Common Questions
Can the D3473 dental code be used for non-molar teeth?
The D3473 code is exclusively intended for surgical repair of root resorption in molar teeth. When treating root resorption in premolars, canines, or incisors, different CDT codes must be utilized. It is essential to verify the appropriate code selection based on both the specific tooth being treated and the exact procedure being performed.
What factors commonly lead to insurance claim denials for D3473?
Insurance providers frequently deny D3473 claims when there is inadequate clinical documentation, missing or poor-quality radiographic evidence, failure to clearly distinguish the procedure from standard endodontic treatments, or when the treatment falls outside the patient's coverage parameters. To minimize denial risk, submit comprehensive clinical notes, high-quality diagnostic imaging, and a detailed procedural narrative.
Is it permissible to bill D3473 alongside other endodontic codes for the same tooth?
The D3473 code covers surgical repair of root resorption and typically should not be combined with other endodontic treatments like root canal therapy or apicoectomy for the same tooth during a single service date, unless both procedures are clinically justified and thoroughly documented as separate treatments. Prior to billing multiple codes, always review specific payer policies to prevent claim denials related to improper bundling or duplicate charges.