D0472Accession of Tissue, Gross Examination, Preparation and Transmission of Written Report

What This Code Covers

D0472 covers the laboratory processing of a tissue specimen that was biopsied from the oral cavity. This includes receiving the tissue at the pathology lab, performing a gross (visual, unaided eye) examination, preparing the specimen, and transmitting a written pathology report back to the treating dentist. This code does not include microscopic examination. It is billed by the pathology lab or the provider performing the pathology review, not by the dentist who took the biopsy.

Billing Guide

Bill this code when:

• A tissue specimen is sent to a pathology lab and only a gross (macroscopic) examination is performed
• The pathologist provides a written report based on gross findings only
• The specimen does not require microscopic analysis for diagnosis
• The gross examination is sufficient to characterize the tissue

Do not bill this code when:

• Microscopic examination is also performed. Use D0473 or D0474 instead
• The biopsy itself is being billed. The biopsy procedure uses D7286 or D7287
• No pathology report is generated
• The specimen is sent to a medical (non-dental) pathology lab that bills under medical CPT codes

Insurance and Denial Prevention

Key Payer Rules:

• D0472 is typically billed by the pathology provider, not the treating dentist
• Most dental plans cover pathology codes when associated with a biopsy procedure
• If the specimen is processed by a medical pathology lab, the lab may bill under medical CPT codes instead of CDT codes
• Some payers may require the biopsy code (D7286/D7287) to be on file before paying the pathology code

Common Denials and How to Respond:

• No associated biopsy on file → Ensure the biopsy procedure code (D7286 or D7287) was submitted. The payer may need to see both the procedure and the pathology charge.
• Wrong code, microscopic exam was performed → If microscopic examination was done, recode to D0473 or D0474 and resubmit.
• Billed by wrong provider → D0472 should be billed by the pathology lab or reviewing pathologist, not the dentist who performed the biopsy.