Understanding Dental Code D7473

When to Use D7473 dental code

The D7473 dental code is designated for the surgical removal of a torus mandibularis—a bony growth found on the lingual surface of the mandible, typically near the premolars. This CDT code should be used when the procedure is medically necessary, such as when the torus interferes with oral function, prosthetic appliance placement (like dentures), or causes discomfort or trauma to the patient. It is not appropriate for cosmetic removal or when the growth does not impact oral health or function. Proper code selection ensures accurate claim submission and reimbursement.

Documentation and Clinical Scenarios

Accurate documentation is critical for successful claims involving D7473. Your clinical notes should clearly describe the size, location, and symptoms caused by the torus mandibularis. Include diagnostic imaging (such as panoramic or periapical radiographs) and a detailed narrative explaining the medical necessity for removal. Common clinical scenarios include:

• Patient experiencing pain or ulceration due to the torus rubbing against oral tissues.
• Interference with the fitting or stability of a lower denture or partial.
• Difficulty with speech or oral hygiene due to the bony growth.

Always attach supporting documentation to the claim, including radiographs and a narrative, to reduce the risk of claim denial.

Insurance Billing Tips

Billing for D7473 requires attention to detail and adherence to payer policies. Here are actionable steps for dental teams:

1. Verify insurance benefits before treatment to confirm coverage for surgical removal of tori. Some plans may classify this as an exclusion or require prior authorization.
2. Submit a pre-authorization with clinical notes and diagnostic images when required by the payer. This can help avoid post-treatment denials.
3. Use the correct CDT code—D7473 specifically refers to mandibular tori. For maxillary tori, refer to the appropriate code (removal of torus palatinus).
4. Include a detailed narrative that outlines the medical necessity, referencing how the torus affects oral function or prosthetic needs.
5. Review the Explanation of Benefits (EOB) promptly and be prepared to submit a claim appeal with additional documentation if the claim is denied.

Staying proactive with insurance verification and thorough documentation streamlines the revenue cycle and reduces accounts receivable (AR) delays.

Example Case for D7473

Case Study: A 62-year-old patient presents for a lower denture. Examination reveals bilateral mandibular tori that prevent proper seating of the appliance. The dentist documents the location and size of the tori, takes panoramic radiographs, and writes a narrative describing the interference with prosthetic placement. The office submits a pre-authorization to the patient’s insurance, attaching all supporting documents. After approval, the procedure is performed and billed under D7473. The claim is processed without delay, and payment is received promptly, demonstrating the value of thorough documentation and insurance coordination.

By following these best practices, dental teams can ensure accurate billing and optimal reimbursement for procedures involving the D7473 dental code.