Understanding Dental Code D3473

When to Use D3473 dental code

The D3473 dental code is designated for the surgical repair of root resorption in molars. This CDT code should be used when a patient presents with internal or external root resorption that requires surgical intervention, specifically on a molar tooth. It is not appropriate for non-surgical management or for teeth other than molars. Accurate code selection is crucial for proper reimbursement and to avoid claim denials.

Documentation and Clinical Scenarios

Proper documentation is essential when billing for D3473. Clinical notes should clearly describe the extent and location of the resorption, the tooth involved (with tooth number), and the specific surgical procedures performed. Radiographic evidence (such as periapical or CBCT images) should be included in the patient record and submitted with the claim when possible. Common clinical scenarios include:

• Severe external resorption due to trauma or orthodontic movement affecting a molar
• Internal resorption identified during endodontic evaluation requiring surgical access and repair
• Cases where root structure compromise threatens tooth stability and cannot be managed non-surgically

Always ensure that the clinical rationale for surgery is well-documented and that alternative treatments have been considered or attempted if appropriate.

Insurance Billing Tips

To maximize reimbursement and minimize delays, follow these best practices when billing D3473:

• Verify coverage: Check the patient’s dental insurance policy for coverage of surgical endodontic procedures, as some plans may have exclusions or waiting periods.
• Pre-authorization: Submit a pre-authorization request with detailed clinical notes and radiographs to confirm coverage before scheduling surgery.
• Accurate coding: Use D3473 only for molars and ensure the procedure description matches the code. If the procedure is performed on a premolar or anterior tooth, reference the appropriate code (see D3471 for anterior teeth or D3472 for premolars).
• Submit supporting documentation: Attach clinical notes, radiographs, and a narrative explaining the necessity of the surgical repair.
• Track EOBs and follow up: Monitor Explanation of Benefits (EOBs) for payment or denial reasons, and be prepared to submit appeals with additional documentation if needed.

Example Case for D3473

A 45-year-old patient presents with pain and mobility in the lower right first molar. Radiographs reveal extensive external root resorption likely due to previous trauma. Non-surgical endodontic therapy is deemed insufficient due to the extent of the defect. The dentist performs a surgical repair, removing resorptive tissue and restoring the root structure. Documentation includes pre- and post-operative radiographs, a detailed narrative, and the procedure note. The claim is submitted with D3473, and insurance pre-authorization was obtained prior to treatment, resulting in prompt reimbursement.

By following these steps and maintaining thorough documentation, dental practices can ensure accurate billing and optimal reimbursement for surgical repair of root resorption in molars using the D3473 dental code.