Understanding Dental Code D7288

When to Use D7288 dental code

The D7288 dental code is designated for a brush biopsy, a minimally invasive procedure used to collect cells from oral lesions for cytological evaluation. This code should be used when a dentist identifies a suspicious oral lesion that does not immediately warrant a scalpel biopsy but still requires further investigation to rule out dysplasia or malignancy. Common clinical scenarios include persistent white or red patches, unexplained ulcers, or lesions that have not resolved after two weeks. Proper use of D7288 ensures that patients receive timely diagnostic care while supporting accurate claim submissions.

Documentation and Clinical Scenarios

Accurate documentation is critical when billing for D7288. The clinical notes should clearly describe the lesion’s appearance, location, size, and duration. Include the rationale for selecting a brush biopsy over other diagnostic methods. Photographs of the lesion, when possible, add value to the patient record and support the medical necessity of the procedure. For example, document: "2x2 mm white patch on left lateral tongue, present for 3 weeks, non-responsive to antifungal therapy. Brush biopsy performed to rule out dysplasia." This level of detail not only supports claim approval but also helps in case of future audits or claim appeals.

Insurance Billing Tips

When billing D7288, verify the patient’s dental insurance policy to confirm coverage for diagnostic procedures. Not all carriers cover brush biopsies, so pre-authorization or a pre-determination of benefits may be necessary. Submit claims with comprehensive clinical notes and, if available, supporting images. If the claim is denied, review the Explanation of Benefits (EOB) for the denial reason and prepare a detailed appeal letter. Include all supporting documentation and reference the patient’s risk factors or symptoms that justified the brush biopsy. Successful dental offices often maintain a checklist for required documentation and follow up with insurance carriers to expedite Accounts Receivable (AR) turnaround.

Example Case for D7288

Consider a 52-year-old patient presenting with a persistent red lesion on the buccal mucosa. The dentist documents the lesion’s characteristics, takes a clinical photo, and performs a brush biopsy, billing under D7288. The claim is submitted with detailed notes and the image. The insurance initially denies the claim, but the office manager submits an appeal, referencing the patient’s history of tobacco use and the lesion’s persistence. The appeal is successful, and the claim is paid. This case highlights the importance of thorough documentation and proactive follow-up in maximizing reimbursement for D7288.