When is D7970 used?
The D7970 dental code applies to the surgical removal of hyperplastic tissue—excessive gum tissue growth—commonly performed before prosthetic work like denture placement, or to treat tissue overgrowth from irritation, poorly fitting dental appliances, or ongoing inflammation. This CDT code is appropriate when the tissue removal represents a separate, billable service rather than being part of another treatment. Correct application of D7970 helps ensure proper payment and adherence to insurance requirements.
D7970 Charting and Clinical Use
Proper documentation is essential for D7970 billing. Clinical records must contain:
Clear identification of hyperplastic tissue condition (such as epulis fissuratum or fibrous hyperplasia).
Comprehensive clinical notes describing tissue location, dimensions, and severity of overgrowth.
Before and after photographs when available to demonstrate medical necessity.
Details of removal method employed (such as scalpel or laser) and type of anesthesia used.
Post-treatment care directions and any noted complications.
Typical clinical situations involve patients experiencing tissue overgrowth from poorly fitting dentures, ongoing irritation from orthodontic devices, or as preparation before installing new prosthetic devices. When tissue removal occurs alongside another treatment, confirm that D7970 isn't included within the main procedure code—consult CDT guidelines or insurance policies regarding bundled services. For instance, when removing tissue during a complete denture treatment, verify whether separate billing is permitted.
Billing and Insurance Considerations
To optimize payment and reduce claim rejections for D7970, implement these strategies:
Confirm benefits prior to treatment by reviewing patient coverage for soft tissue removal procedures.
Include comprehensive narratives with claims, describing medical necessity and providing supporting materials (photographs, x-rays, clinical notes).
Apply proper CDT coding and prevent inappropriate unbundling of services. When another code more accurately describes the treatment, select that alternative.
Contest denials quickly using additional documentation when claims are refused. Reference clinical standards and provide before-and-after photographs when possible.
Review EOBs (Explanation of Benefits) and track accounts receivable to ensure prompt follow-up on outstanding claims.
Most insurance companies require evidence that the removal was medically necessary rather than cosmetic and essential for oral health or prosthetic function. Always review insurer-specific guidelines for documentation needs and treatment frequency restrictions.
How dental practices use D7970
Case: A 68-year-old patient arrives with extensive hyperplastic tissue in the upper front area, resulting from prolonged use of an improperly fitting upper denture. This tissue prevents proper fitting of a replacement prosthesis. Following clinical assessment and documentation, the dentist removes the hyperplastic tissue using a scalpel with local anesthesia. Before and after photographs are captured, and the patient receives follow-up scheduling and new denture impression appointments.
Billing Process:
Confirm patient insurance coverage for D7970 and secure pre-authorization when necessary.
Record the diagnosis, treatment specifics, and removal necessity in patient charts.
Process the claim using D7970, including detailed narrative and supporting photographs.
Track EOB and accounts receivable for payment updates, and file appeals with additional documentation if denied.
This method ensures appropriate compensation and validates the clinical necessity for treatment, minimizing claim denial risk and improving revenue cycle efficiency.
Common Questions
Can D7970 be billed together with other procedures in the same appointment?
D7970 may be billed with other procedures when they are medically necessary and represent separate, distinct services. However, insurance companies often review these claims carefully for potential unbundling issues. It's essential to maintain separate documentation and justification for each procedure performed. Review your payer's specific bundling policies and apply appropriate modifiers when necessary.
Are there restrictions on how frequently D7970 can be billed for the same patient?
Most insurance carriers establish frequency limits for surgical excision procedures like D7970. Typical restrictions include coverage once per anatomical site or within specific timeframes, such as annually. To prevent claim denials, always confirm plan-specific frequency limitations prior to performing the procedure.
What steps should be taken if pathology findings reveal a more serious diagnosis after filing a D7970 claim?
When pathology results indicate a diagnosis requiring a different or additional CDT code, such as neoplastic conditions, you may need to amend or supplement your original claim submission. Reach out to your insurance carrier to understand their process for claim corrections or resubmissions, and be prepared to provide updated clinical documentation along with the pathology report.