When is D7472 used?
The D7472 dental code applies to the surgical removal of a torus palatinus, which is a benign bony protrusion found on the roof of the mouth. This CDT code is appropriate when a dental professional performs surgery to eliminate this growth, often because it interferes with normal oral function, prevents proper fitting of dental appliances, or causes patient discomfort. D7472 should only be applied when the procedure specifically targets a palatal torus, since separate codes exist for other types of oral bony growths or tori. Proper code usage helps ensure correct claim processing and appropriate reimbursement.
D7472 Charting and Clinical Use
Thorough documentation plays a vital role in successful insurance processing for D7472 claims. Patient records must clearly outline the dimensions, position, and related symptoms of the torus palatinus. Supporting materials like clinical photographs, X-rays, and comprehensive notes explaining why removal is medically necessary (such as denture fitting issues or repeated tissue injury) help validate the claim. Typical clinical situations include:
Patient needs an upper denture, but the palatal torus blocks proper placement.
Ongoing tissue irritation or injury to the area covering the torus.
Problems with speaking or swallowing caused by the bony formation.
Patient files must contain complete pre-surgical and post-surgical documentation, signed consent paperwork, and relevant diagnostic imaging.
Billing and Insurance Considerations
When processing claims for D7472, dental practices should implement these strategies to improve approval rates and reduce processing delays:
Check insurance benefits: Surgical tori removal isn't covered by every dental plan. Confirm coverage details and record any restrictions or exclusions prior to treatment.
Provide complete documentation: Include patient records, diagnostic images, and detailed medical necessity explanations with your initial claim.
Apply appropriate CDT codes: Use D7472 exclusively for palatal tori. For lower jaw tori, reference the specific code for mandibular tori procedures.
Track EOBs and accounts receivable: Examine Explanation of Benefits statements quickly. For denied claims, identify documentation gaps or coding mistakes, then file appeals with additional evidence within required timeframes.
Patient communication: Discuss possible patient costs and secure financial agreement before starting treatment.
How dental practices use D7472
A 62-year-old patient visits for upper complete denture construction. Examination reveals a large torus palatinus that interferes with proper denture seating. The dentist records the torus measurements and location, captures intraoral photos, and informs the patient that surgical removal is required for successful prosthetic treatment. Following patient consent, the dentist completes the surgical removal and files an insurance claim using D7472, accompanied by comprehensive supporting materials. The insurance provider approves payment after evaluating the detailed explanation and photographic evidence, allowing the patient to continue with denture construction successfully.
Following these documentation and billing guidelines helps dental practices achieve proper reimbursement and create positive experiences for both the office and patients when utilizing the D7472 dental code.
Common Questions
Can D7472 be used for removing bony growths outside the palate area?
D7472 is exclusively designed for the surgical removal of torus palatinus, which refers to bony growths specifically located on the palate. When dealing with bony growths in other oral locations, such as the mandible, practitioners should utilize different CDT codes like D7471 instead.
What are typical reasons insurance companies deny D7472 claims?
Insurance denials for D7472 commonly occur due to inadequate documentation demonstrating medical necessity, absence of supporting diagnostic imaging, failure to obtain required pre-authorization, or improper application of CDT codes and modifiers. Comprehensive documentation and adherence to payer requirements can significantly reduce denial rates.
Is it possible to bill D7472 together with other oral surgery procedures in a single visit?
D7472 can indeed be billed concurrently with additional oral surgery procedures when medically warranted. The key requirements include applying appropriate CDT modifiers and providing comprehensive documentation that clearly differentiates each procedure while demonstrating their individual medical necessity to the insurance provider.