D7465 — It’s a Laser, Now What?
The laser has continually evolved into becoming one of the most powerful operative tools available to dentistry. Its many variations and flexibilities allow for today’s clinician to not only simplify, but also streamline most facets of specialty and general dentistry.
It’s a “hot topic” of late as more dentists are considering the purchasing of lasers but yet are wondering, “Where do I go from here?” This is a broad question that when broken down really asks, “What is the best way to bill and see a return on my investment, AKA the laser?”
However, the laser is not alone in this overall concept. The same can be said for cone beam and CT scan technologies, as well as digital impression techniques, and the many forms of in-office and laboratory-based CAD/CAM systems.
In this issue of Dental Insurance Today, and in the following three issues, I will open your eyes to a more simplified world of insurance reimbursement management. It’s not that hard to understand. However, there are steps to the process. Whether I’m teaching a class or consulting with a practice, I have found that there are basically similar questions that always get asked. It doesn’t matter if it’s in the morning or afternoon session; it doesn’t even matter if I’m on the east coast or west coast, the questions are generally the same.
I will be diving into these four questions, thoroughly exploring each one in subsequent issues. Take a few seconds and ask yourself which of these relate to your office and immediate situation. Is it 1 or 2, or maybe 2 and 3, or perhaps all four? And definitely number 4!
- If I buy this laser (or invest in the technology), how do I bill for using it so I can get an immediate return on investment?
- What code numbers do I use so the insurance company will pay and not ask questions?
- Can I bill the patients’ medical insurance plan?
- How do I make (more) money in dentistry? – These write-offs are killing me.
Let’s explore question No. 1.
How do I bill for using this laser so I get an immediate return on investment?
Dental lasers have two primary functions; they cut and they destroy. So what are we cutting? And, what are we destroying? If we are destroying a lesion, we have a specific code that identifies the completed procedure. That code is D7465.
D7465 – destruction of lesion(s) by physical or chemical method, by report.
Examples include using cryo, laser or electro surgery. (CDT-2016)
Code D7465 is the one and only procedure code that is specifically technique-sensitive to the laser. Rather than being surgically removed, the pathologic lesion is simply obliterated. For all other procedures where the laser is used, report the code that most accurately describes the intended as well as completed procedure.
For a frenectomy, the code is most often D7960 but when it’s a frenuloplasty, it’s D7963. For a periodontal gingivectomy, the code is either D4210 (four or more teeth) or D4211 (one to three teeth) and it’s D4212 when, after healing and resolution, a separate restorative procedure is completed. Yes, that is correct. Most all plans exclude benefits for D4212 when done on the same day as the restoration.
In a true fee-for-service environment, we simply identify and subsequently bill the patient for each completed procedure, as it is finished. The operative word here is COMPLETED. What code identifiable procedure did we do? And remember, it’s not finished or completed until there is absolutely nothing remaining that needs to be done. Production, billing, and subsequent collections are based on the finished procedure, not the technique utilized to complete it.
We must remember that a laser is nothing more than an adjunctive instrument that is utilized to complete a more definitive procedure. You would not routinely explain on a claim that you used a #11 or #15 Bard-Parker blade. Your treatment notes, however, are another story.
Benefit plans reimburse based upon the completed procedure. They accept no additional liability for the use of a laser, and most all plans disallow the office from separately charging the patient beyond the scope of the completed claim. The same holds true for the use of either a curved or straight blade. With the partial exception of D7465, CDT codes identify completed procedures, not specific techniques.
This same concept of CAC or “code at conclusion” is applicable to all technology integrations as concerns patient care. Bill and code for the completed procedure. Bill and code for exactly what it was you did as a completed entity. And here is the easy part – when the claim to the payer comes last in the sequence of events, you’ll never have the question as to what was completed and needs to be coded. Once you know what is completed and done, the process of code selection becomes automatic.
Question No. 2…
In our next issue, question No. 2, “What code numbers do I use so the insurance company will pay and not ask questions?” will be explored in depth. I will be sharing with you more of my simplified metric, whereby the clinical documentation on the date of treatment directs you every time to the one and only appropriate procedure code, thereby eliminating the forever concept of fraudulent concept of a “coding strategy.”
I’m eager to know your thoughts, so let me hear from you.
Until the next issue,
Tom M. Limoli, Jr.

Tom Limoli
“The Nation’s Leading Reimbursement Expert”
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Can the Ada code D7465 be used to insurance reimbursement for our patients with chronic cold sores that are helped with laser treatment?
Sure can. Check out the blog on Laser. A printable version is in the membersection under the tab “Limoli Says”
I got a treatment with laser and I was told there’s no procedure code for this and they cannot bill my insurance for that. So they charged me $300 for using laser in my treatment. Is this fair?
No, it is not fair. Do you recall why the doctor needed to use a laser? Was it used to treat a sore? Make an incision or cut? Treat gum disease or facial pain? Did you get some type of receipt for the $300 you paid?
Hi Tom, I attended a course of yours several years ago. I learned a lot and appreciated that course. Question about D7465, if you use a Gemini Laser to aid in healing or help with joint pain, can you bill this code D7465 as opposed to a D4999 code?
That would be a definite NO as you are not destroying a lesion(s). In that D7465 is “by report” you clinical documentation would have to be falsified and we definitely don’t want to go there. Unspecified perio at D4999 is also out of line as you are addressing joint pain. Your best and only accurate coding is within the definition of D7899 as this is for an unspecified TMD therapy that is also identified as being by report. It is my honor to be of service.
Can a hygienist code out D7465 when treating a cold sore? Or does this have to be coded under the dentist.
Hi Holly. That is going to be a question for your specific state dental board. Most all states have specific criteria as to what can and cannot be done by a hygienist. It is my honor to be of service