When is D7286 used?
The D7286 dental code applies to incisional biopsy of oral tissue – soft. This CDT code is appropriate when a dental professional takes a sample of questionable soft tissue for laboratory analysis, rather than removing the complete lesion. It differs from excisional biopsies, which involve total removal and use different codes. Apply D7286 when the treatment goal is to collect a tissue sample for diagnostic purposes, especially when the lesion's characteristics are unclear or cancer is a concern.
D7286 Charting and Clinical Use
Proper documentation is crucial for appropriate reimbursement and regulatory compliance. The patient record must clearly include:
Clinical observations that led to the biopsy decision (such as ongoing ulceration, unexplained swelling, unusual mucosal changes).
The site, dimensions, and features of the lesion.
The reasoning for choosing an incisional (rather than excisional) biopsy approach.
Procedure specifics, including anesthetic type, tissue collected, and any adverse events.
Typical clinical situations for D7286 include:
Questionable white or red lesions (leukoplakia or erythroplakia) requiring diagnostic confirmation.
Lesions that are oversized or positioned where complete excision would be unsuitable or risky.
Sites where cancer is possible but verification is necessary prior to comprehensive treatment.
Billing and Insurance Considerations
To maximize successful claim approval for D7286, implement these strategies:
Check coverage beforehand: Confirm with the patient's dental plan whether biopsy procedures are included and if medical billing is necessary.
Include supporting materials: Provide clinical documentation, oral photographs, and laboratory reports to demonstrate treatment necessity.
Apply the appropriate CDT code: Avoid mixing up D7286 with excisional biopsy codes (D7287) or hard tissue biopsy codes (D7285).
Work with medical coverage: Certain policies may need medical insurance submission initially, particularly when malignancy is suspected. Apply proper cross-referencing (such as CPT 40808) when required.
Monitor claims and pursue follow-up: Review EOBs and accounts receivable to confirm prompt payment. Prepare to file appeals with extra documentation if claims are rejected.
How dental practices use D7286
A patient arrives with a continuing, irregularly bordered red lesion on the cheek lining. Following comprehensive evaluation and record-keeping, the dentist decides an incisional biopsy is needed to exclude dysplasia or malignancy. The treatment is completed using local numbing, and a tissue sample is forwarded for analysis. The practice files a claim with D7286, including clinical records and laboratory forms. When the insurance company requests more details, the office quickly supplies oral images and a detailed explanation. The claim receives approval, and reimbursement is recorded in the patient account, showing successful billing procedures and proper documentation practices.
Common Questions
Is it possible to bill D7286 together with other dental treatments on the same visit?
D7286 can typically be billed with other dental procedures completed during the same appointment, including comprehensive oral evaluations (D0120). Each procedure must be medically necessary with proper documentation. Insurance providers may have specific requirements for separate documentation or may bundle certain services, so verify payer policies and provide clear documentation when multiple services are rendered.
Which dental professionals are authorized to perform D7286 procedures?
Licensed dental professionals including general dentists, oral surgeons, and periodontists with proper biopsy training are qualified to perform D7286 procedures. While dental hygienists cannot perform biopsies, they play an important role in identifying suspicious lesions and making appropriate referrals to qualified dentists for evaluation and biopsy procedures.
What elements must be present in the pathology report for D7286?
A complete pathology report for D7286 must contain a comprehensive tissue sample description, diagnostic findings or results, and recommendations for additional treatment or follow-up care. This report must be maintained in the patient's clinical record and may be necessary for insurance claims processing or future treatment planning decisions.