Understanding Dental Code D7485

When to Use D7485 dental code

The D7485 dental code is used for the reduction of an osseous tuberosity, a procedure often necessary to create adequate space for prosthetic appliances such as dentures. This CDT code applies when the bony prominence in the maxillary or mandibular region interferes with the fit, comfort, or function of a dental prosthesis. Dentists should use D7485 only when clinical evaluation confirms that the osseous tuberosity is causing a functional problem that cannot be resolved through less invasive means. Proper use of this code ensures accurate reporting and reimbursement for surgical interventions that facilitate restorative dental care.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing for D7485. The clinical record should include:

• Detailed clinical notes describing the location, size, and impact of the osseous tuberosity.
• Pre-operative radiographs or intraoral photographs demonstrating the need for reduction.
• Clear documentation of the patient’s symptoms or prosthetic challenges caused by the tuberosity.
• A narrative explaining why alternative treatments were not suitable.

Common clinical scenarios include patients preparing for full or partial dentures, where the bony prominence prevents proper seating of the appliance. In some cases, D7485 may be used in conjunction with other surgical codes, such as bone grafting procedures, but each service must be distinctly documented to avoid claim denials.

Insurance Billing Tips

To maximize reimbursement and minimize delays, follow these best practices when billing D7485:

• Pre-authorization: Always verify insurance benefits and obtain pre-authorization if required. Submit supporting documentation, including clinical notes and radiographs, with your request.
• Claim submission: Attach a detailed narrative and all supporting images to the initial claim. Clearly indicate the relationship to prosthetic treatment.
• Coordination of benefits: If the patient has multiple insurance plans, coordinate benefits to ensure proper payment order and avoid duplicate billing.
• Appeals: If a claim is denied, review the Explanation of Benefits (EOB) for the reason, and submit a timely appeal with additional documentation or clarification as needed.

Consistent, thorough documentation and proactive communication with payers are key to successful billing of D7485 and similar surgical procedures.

Example Case for D7485

Consider a 67-year-old patient scheduled for a maxillary complete denture. During the initial evaluation, the dentist notes a pronounced maxillary tuberosity that impedes the seating of the impression tray. Radiographs confirm the bony prominence, and the patient reports discomfort when attempting to wear a temporary appliance. After discussing options, the dental team determines that reduction of the osseous tuberosity is necessary. The procedure is performed, documented with before-and-after photos, and a detailed narrative is included in the patient’s record. The claim for D7485 is submitted with all supporting documentation, resulting in prompt insurance approval and payment.

By following best practices for documentation and insurance submission, dental teams can ensure appropriate reimbursement for procedures billed under the D7485 dental code.