When is D7473 used?
The D7473 dental code applies to the surgical excision of torus mandibularis—a benign bony protrusion located on the tongue-side surface of the lower jaw, commonly found near the bicuspid area. This CDT code is appropriate when the removal is clinically necessary, including situations where the torus creates functional problems, prevents proper fitting of dental prosthetics (such as complete or partial dentures), or results in patient discomfort or tissue injury. The code should not be applied for purely aesthetic procedures or when the bony growth poses no functional or health concerns. Correct code usage helps ensure proper claim processing and payment.
D7473 Charting and Clinical Use
Thorough documentation plays a vital role in successful claim processing for D7473. Clinical records must clearly outline the dimensions, position, and clinical symptoms associated with the mandibular torus. Documentation should include appropriate diagnostic images (panoramic or intraoral radiographs) along with a comprehensive treatment note explaining why removal is clinically indicated. Typical clinical situations include:
Patient reports discomfort or tissue irritation caused by the torus contacting surrounding soft tissues.
Bony growth prevents adequate fit or retention of lower prosthetic appliances.
Torus creates challenges with proper oral care or affects normal speech patterns.
Supporting materials, including radiographic images and detailed treatment notes, should accompany all claims to minimize denial risks.
Billing and Insurance Considerations
Processing claims for D7473 demands careful attention to payer requirements and comprehensive documentation. Consider these practical approaches for dental offices:
Check coverage details prior to treatment to ensure the patient's plan covers torus removal procedures. Certain insurance policies may exclude this treatment or mandate advance approval.
Request pre-treatment authorization when mandated by the insurance carrier, including clinical documentation and radiographic evidence. This approach helps prevent treatment denials.
Apply the appropriate CDT code—D7473 is specific to lower jaw tori. For upper jaw tori removal, reference the corresponding code (torus palatinus excision).
Provide comprehensive treatment notes explaining the clinical justification, describing how the torus impacts function or prosthetic treatment.
Monitor claim responses carefully and prepare appeal documentation with additional clinical support if initial claims are rejected.
Proactive insurance verification combined with complete clinical documentation helps optimize practice revenue and minimizes payment delays.
How dental practices use D7473
Clinical Example: A 62-year-old patient requires a new lower complete denture. Clinical examination shows bilateral mandibular tori that interfere with proper denture placement. The treating dentist records the tori's position and dimensions, obtains panoramic imaging, and creates detailed treatment notes explaining how the bony growths prevent adequate prosthetic fit. The practice requests insurance pre-authorization, submitting all clinical evidence. Following approval, the surgical removal is completed and submitted using D7473. The claim processes smoothly with timely payment, highlighting the importance of proper documentation and insurance coordination.
Following these guidelines helps dental practices achieve accurate claim submission and maximize reimbursement when using the D7473 dental code.
Common Questions
Can D7473 be covered by medical insurance rather than dental insurance?
In uncommon situations, D7473 might be covered under medical insurance when torus mandibularis removal is considered medically necessary due to underlying health issues or when it's part of a comprehensive surgical treatment. Typically, this procedure code is processed through dental insurance. It's important to verify coverage with the patient's medical insurance provider and ensure complete documentation when filing medical insurance claims.
What preparation is needed for patients before torus mandibularis removal?
Patient preparation typically includes a thorough oral examination, medical history review, and detailed discussion about the procedure, potential risks, and post-surgical care instructions. Pre-surgical guidelines may require fasting when sedation is used, arranging post-procedure transportation, and temporarily stopping specific medications as recommended by the dental surgeon.
What postoperative complications commonly occur with D7473 procedures and how are they treated?
Typical post-surgical complications include swelling, pain, minor bleeding, and occasionally infection or slow healing. Patients must receive comprehensive post-operative care instructions covering proper oral hygiene, pain control methods, and warning signs requiring immediate medical attention. Scheduled follow-up visits are essential for monitoring healing progress and addressing complications promptly.