Understanding Dental Code D7287

When to Use D7287 dental code

The D7287 dental code refers to the collection of an exfoliative cytological sample, a procedure used to gather cells from the oral mucosa for microscopic examination. This code is most commonly used when a dentist or oral health professional identifies suspicious lesions, ulcers, or abnormal tissue in a patient’s mouth that require further investigation but may not yet warrant a full biopsy. D7287 is appropriate for screening potentially malignant disorders, monitoring changes in chronic lesions, or following up on previously identified abnormalities. It is not intended for routine oral exams or when a definitive histopathological diagnosis is already being pursued via biopsy.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing for D7287. The clinical notes should clearly describe the reason for the cytological sample, the site of collection, and any relevant findings that prompted the procedure. For example, if a patient presents with a persistent white patch (leukoplakia) on the buccal mucosa, the provider should document the lesion’s size, appearance, duration, and any risk factors (such as tobacco use). The procedure note should include the method of sample collection (e.g., brush or spatula), patient tolerance, and any immediate findings. Attaching intraoral photographs or diagrams can further support the claim. Common scenarios for D7287 include evaluation of suspicious white or red lesions, monitoring lichen planus, or assessing unexplained ulcerations.

Insurance Billing Tips

When submitting claims for D7287, ensure the procedure is medically necessary and supported by detailed clinical documentation. Most dental benefit plans consider D7287 a diagnostic adjunct, and coverage may vary. Before performing the procedure, verify the patient’s benefits and whether prior authorization is required. Attach supporting documentation such as clinical notes, photographs, and a narrative explaining the rationale for cytological sampling. If the claim is denied, review the explanation of benefits (EOB) for the denial reason and be prepared to submit an appeal with additional supporting evidence. For cases where a biopsy is later performed, reference the related code (see D7286 excisional biopsy) and ensure the services are not billed as duplicates.

Example Case for D7287

A 52-year-old patient presents with a non-healing red and white patch on the lateral border of the tongue, present for over three weeks. The dentist documents the lesion’s characteristics, patient history, and risk factors. After discussing options, the provider collects an exfoliative cytological sample using a brush technique, documents the procedure, and sends the sample for laboratory analysis. The claim is submitted with D7287, accompanied by clinical notes and intraoral photos. The insurance plan requests additional information, so the office submits a narrative and receives approval for reimbursement. The cytology results guide the next steps in patient care, demonstrating the value of proper use and documentation of D7287.