Understanding Dental Code D0472

When to Use D0472 dental code

The D0472 dental code is used for the accession of tissue, gross examination, preparation, and transmission of a written report. This CDT code is specifically applied when a dental provider collects tissue—often from a biopsy or surgical procedure—sends it for gross examination (without microscopic analysis), and generates a written report based on the findings. It is important to use D0472 only when the examination does not require microscopic evaluation, which is billed under different codes such as D0473 for microscopic examination.

Documentation and Clinical Scenarios

Proper documentation is crucial for successful reimbursement and compliance. When using D0472, ensure the patient’s chart includes:

• Detailed clinical notes describing the reason for tissue removal
• Specimen labeling and handling records
• A copy of the gross examination report
• Clear indication that no microscopic examination was performed

Common clinical scenarios for D0472 include removal of benign oral lesions, excisional biopsies where only a gross (visual and tactile) inspection is performed, or when tissue is sent to a pathology lab for gross-only evaluation. Always confirm that the procedure matches the code’s definition to avoid claim denials.

Insurance Billing Tips

Accurate billing for D0472 requires attention to detail and proactive communication with payers. Here are best practices:

• Verify coverage: Before performing the procedure, check the patient’s dental benefits to confirm coverage for tissue examination codes.
• Submit supporting documentation: Attach clinical notes and the written report to your claim to support medical necessity.
• Use correct modifiers: If D0472 is performed along with other pathology services, ensure you use appropriate CDT modifiers to distinguish between services.
• Review EOBs promptly: Examine Explanation of Benefits statements for payment accuracy and quickly address any denials or underpayments through claim appeals.

Staying up to date with payer policies and CDT code updates will help your dental office avoid AR delays and maximize reimbursement.

Example Case for D0472

Case Scenario: A patient presents with a small, benign-appearing lesion on the buccal mucosa. The dentist excises the lesion and sends the tissue to a pathology lab for gross examination only. The lab visually inspects the tissue, documents findings, and provides a written report. No microscopic analysis is performed. The dental office bills D0472, attaching the clinical notes and the lab’s gross examination report to the insurance claim. The claim is processed and paid without delay, thanks to thorough documentation and accurate code selection.

By understanding when and how to use the D0472 dental code, dental teams can streamline billing, reduce claim denials, and ensure compliance with industry standards.