D0431: Adjunctive Pre-Diagnostic Test that Aids in Detection of Mucosal Abnormalities Including Premalignant and Malignant Lesions, Not to Include Cytology or Biopsy Procedures

As explained by the experts at DentalRevu, the D0431 Dental Code initially used to represent a “Genetic Test for Susceptibility to Oral Diseases”. This involved collection of samples for certified laboratory examination in order to detect particular genetic variants associated with higher susceptibility to oral disorders such as severe periodontal disease.

The code was all-inclusive in the sense that it was used for reporting both the collection of the lab report and sample. For example, if a dentist were to prescribe a MyPerioIDSM PST® Test, the biller would code it as D0431, but this CDT code was seldom covered by any dental plans.

2022 Update to the D0431 Dental Code

According to the CDT Dental Code update for 2022, D0431 is a screening test for visual cancer detection; it is not to be mistaken with a biopsy, which is coded differently (possibly D7288 brush biopsy which harvests transepithelial cells).

A biopsy or referral to an oral surgeon may be considered if the dentist notices abnormalities in the mucosa during a visual examination of the mouth. Often, this service is introduced during the hygiene visit.

The hygienist can perform a preliminary screening, but the dentist must additionally analyze and make a final determination of the presented problem and diagnosis before the treatment can be reported to insurance companies. In order to receive payment for your services, you’ll need to keep detailed clinical records.

A visual and physical examination are both part of a basic oral cancer screening. Color and texture abnormalities are examined during a visual inspection by the dentist. Dentists use their hands to check for abnormalities in the mouth.

An expanded oral cancer exam includes new ways for detecting abnormalities in the mucosa. In order to distinguish between healthy and pathological oral tissue responses, VELscope® uses a unique blue light that causes tissue fluorescence.

Chemiluminescent light and a blue dye are used in ViziLite® Plus with TBlue630® to temporarily label lesions so they can be more easily identified. Code D0431 can be used to report the use of VELscope® and/or ViziLite® Plus with TBlue630®.

Please Note: Dentists may consider brush biopsy (D7288), excisional biopsy (D7286), or a referral to an oral surgeon for additional assessment if D0431 results are positive.

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