Understanding Dental Code D7472

When to Use D7472 dental code

The D7472 dental code is designated for the removal of a torus palatinus, a bony growth located on the palate of the mouth. This CDT code should be used when a dentist or oral surgeon performs a surgical procedure to remove this growth, typically due to interference with oral function, prosthetic appliance placement, or patient discomfort. It is essential to use D7472 only when the procedure specifically addresses a palatal torus, as other codes exist for different oral tori or bony growths. Accurate code selection ensures proper claim processing and reimbursement.

Documentation and Clinical Scenarios

Proper documentation is critical for successful insurance claims involving D7472. Clinical notes should clearly describe the size, location, and symptoms associated with the torus palatinus. Photographs, radiographs, and a detailed narrative explaining the medical necessity for removal (such as interference with a denture or recurrent trauma) strengthen the claim. Common clinical scenarios include:

• Patient requires a maxillary denture, but the torus palatinus prevents proper fit.
• Recurrent ulceration or trauma to the palatal tissue overlying the torus.
• Speech or swallowing difficulties directly attributed to the bony growth.

Always ensure that the patient's chart includes pre- and post-operative notes, consent forms, and any supporting diagnostic images.

Insurance Billing Tips

When billing for D7472, dental teams should follow these best practices to maximize claim acceptance and minimize delays:

• Verify insurance coverage: Not all dental plans cover surgical removal of tori. Confirm benefits and document exclusions or limitations before treatment.
• Submit comprehensive documentation: Attach clinical notes, diagnostic images, and a narrative of medical necessity with the initial claim submission.
• Use correct CDT codes: Ensure D7472 is used only for palatal tori. For mandibular tori, refer to the appropriate code for mandibular tori removal.
• Monitor EOBs and AR: Review Explanation of Benefits (EOBs) promptly. If a claim is denied, check for missing documentation or coding errors, and submit a timely appeal with additional supporting evidence.
• Educate patients: Inform patients about potential out-of-pocket costs and obtain financial consent prior to the procedure.

Example Case for D7472

Consider a 62-year-old patient who presents for fabrication of a maxillary complete denture. During the exam, a prominent torus palatinus is noted, preventing the denture from seating properly. The dentist documents the size and location of the torus, takes intraoral photographs, and explains to the patient that removal is necessary for successful prosthesis placement. After obtaining consent, the dentist performs the surgical removal and submits a claim using D7472, including all supporting documentation. The insurance company approves the claim after reviewing the detailed narrative and images, and the patient proceeds with denture fabrication without further complications.

By following these documentation and billing best practices, dental offices can ensure accurate reimbursement and a smooth experience for both the practice and the patient when using the D7472 dental code.