Understanding Dental Code D7471

When to Use D7471 dental code

The D7471 dental code is designated for the removal of lateral exostosis—bony growths—on the maxilla (upper jaw) or mandible (lower jaw). This CDT code should be used when a patient presents with a benign bony protuberance that interferes with oral function, prosthetic appliance placement, or causes discomfort. It is not intended for removal of tori (see D7472 for palatal tori removal) or for simple bone contouring during routine extractions.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful claim submission and reimbursement. When using D7471, ensure the patient’s chart includes:

• Detailed clinical notes describing the location, size, and symptoms caused by the exostosis.
• Radiographic evidence (such as panoramic or periapical X-rays) supporting the diagnosis.
• Pre- and post-operative photos when possible, to illustrate medical necessity.
• Procedure narrative outlining the technique, anesthesia used, and any complications.

Common scenarios for D7471 include patients who cannot comfortably wear dentures due to bony overgrowth, or those experiencing chronic irritation from the exostosis.

Insurance Billing Tips

Proper billing for D7471 can improve reimbursement rates and reduce denials. Here are best practices:

• Verify benefits before treatment by contacting the patient’s dental insurance and confirming coverage for surgical removal of exostosis under D7471.
• Submit comprehensive documentation with the claim, including clinical notes, radiographs, and a clear narrative explaining medical necessity.
• Use correct CDT coding and avoid upcoding or miscoding. If additional procedures are performed (e.g., alveoloplasty), code them separately with appropriate documentation.
• If denied, review the EOB (Explanation of Benefits) and prepare a claim appeal with additional supporting documentation, such as letters of medical necessity or specialist referrals.

Example Case for D7471

Consider a 62-year-old patient who presents with discomfort while wearing a lower partial denture. Examination reveals a pronounced bony growth on the buccal aspect of the mandible. Radiographs confirm a lateral exostosis. After verifying insurance benefits, the dental team documents the findings, obtains pre-op photos, and submits a pre-authorization request. The procedure is performed under local anesthesia, and the exostosis is removed. Post-op documentation and photos are added to the patient’s record. The claim is submitted with all supporting materials, resulting in prompt reimbursement.

By following these steps and understanding the nuances of the D7471 dental code, dental practices can ensure accurate billing, minimize claim denials, and optimize patient care outcomes.