Dental Billing Codes for Gingivectomy – A Surgical Periodontic Procedure

by | Published on Oct 26, 2022 | Specialty Billing

Dental Billing Codes for Gingivectomy
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Regarded as a common and serious kind of gum infection, periodontal disease occurs due to infections and inflammation of the gums and bone that surround and support the teeth.

According to the American Dental Association nearly 47.2 percent of Americans over age 30 years have some form of periodontal disease (also known as gum disease). The condition is usually the result of poor oral hygiene. Therefore, brushing at least twice a day, flossing daily and undergoing regular dental checkups can help reduce the chances of developing periodontal disease. If left untreated, periodontal disease can seriously infect the roots of the teeth, making them loose or uncomfortable. In severe cases, dentists will advise gingivectomy – the surgical removal of gingival or gum tissue – to correct the condition. Getting reimbursed for different types of gingivectomy procedures can be challenging. Dental offices can rely on outsourced dental billing services to submit claims with the correct CDT codes in compliance with the payer guidelines to ensure accurate claim submission.

What Is Gingivectomy and Who Is an Ideal Candidate for the Procedure?

Gingivectomy is a dental procedure that may be performed to heal the effects of periodontal disease or to correct a gum condition involving the structures around the teeth. Periodontal disease develops when bacteria present in the mouth attaches to the teeth and forms a biofilm called plaque. As the plaque continues to accumulate and moves below the gum line, the gum tissue becomes more inflamed causing severe bleeding. In addition, the area between the tooth and gum tissue can deepen to form a periodontal pocket.

Considered one of a few procedures that help reverse periodontal issues, gingivectomy is surgical removal of gum tissue, or gingiva. The procedure is commonly performed to treat gum conditions like gingivitis. It may be used to remove extra gum tissue for cosmetic reasons, such as to modify a smile. A dentist may recommend gingivectomy if the patient suffers from gum recession due to factors like – aging, bacterial infections, gum diseases (like gingivitis) and gum injury.

How Is a Gingivectomy Performed?

Generally, gingivectomy takes 30-60 minutes, depending on how much gum tissue the dentist removes. Minor procedures involving a single tooth or several teeth will probably involve or require a single session. On the other hand, major gum removal or reshaping may take several visits, especially if the dentist wants one area to heal before moving on to the next.

Gingivectomy procedure begins with the dentist injecting local anesthetic into the gums to numb the area. The dentist uses a scalpel or laser tool to cut away or vaporize remaining pieces of gum tissue (called soft tissue incision) and shape the gum line. In some instances, a low frequency laser may be used. During the procedure, dentist will likely keep a suction tool in the mouth to remove excess saliva. The diseased tissue is trimmed and removed; the remaining gums are reattached in and around the teeth by sutures (stitches) to protect the gums while they heal and the area is cleaned with saline and special rinses. On completion of the procedure, a surgical dressing, or pack, is placed in and around the teeth and gums. This dressing is left in place for about a week. Swishing with an antibacterial mouthwash can help in the healing process.

Typically, recovery from gingivectomy is quick and patients can return home right away. Soon after the procedure, patients may not experience any pain, but as the numbing wears off a few hours after the procedure, the pain may become sharper or more persistent. Dentists may prescribe over-the-counter pain medication like acetaminophen (Tylenol) or ibuprofen (Advil) that may help ease the pain. For a few days after the procedure, the gums will bleed. Replace bandages or dressings until bleeding stops or until the dentist advises that the gums can be exposed again.

Patients may experience some jaw pain. Dentists, in such cases, will advise patients to eat only soft foods so that eating does not irritate or damage the gums as they heal. Patients may need to apply a cold compress to their cheeks to soothe any pain or irritation that spreads into their mouth. Use a warm saltwater rinse or saline solution to keep the area free of bacteria or other irritating substances, but avoid mouthwash or other antiseptic liquids. Antibiotics may also be prescribed to prevent gum infections. Most patients can return to a normal oral care regimen in less than a month after the procedure. Regular dental check-ups and follow-up visits with a dentist or periodontist will ensure the success of the surgical procedure.

CDT Codes for Gingivectomy

  • D4210 Gingivectomy or gingivoplasty – four or more contiguous teeth or tooth bounded spaces per quadrant
  • D4211 Gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant
  • D4212 Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth
  • D4230 Anatomical crown exposure – four or more contiguous teeth or bounded tooth spaces per quadrant
  • D4231 Anatomical crown exposure one to three teeth or bounded tooth spaces per quadrant
  • D4240 Gingival flap procedure, including root planing – four or more contiguous teeth or tooth bounded spaces per quadrant
  • D4241 Gingival flap procedure, including root planing – one to three contiguous teeth or tooth bounded spaces per quadrant
  • D4245 Apically positioned flap
  • D4249 Clinical crown lengthening – hard tissue
  • D4260 Osseous surgery (including flap entry and closure) – four or more contiguous teeth or tooth bounded spaces per quadrant
  • D4261 Osseous surgery (including flap entry and closure) – one to three contiguous teeth or tooth bounded spaces per quadrant
  • D4274 Mesial/distal wedge procedure, single tooth (when not performed in conjunction with surgical procedures in the same anatomical area)
  • D4999 Unspecified periodontal procedure, by report

Medical billing and coding for dental procedures or surgeries can be complex and requires adequate knowledge of the changing coding and billing standards. Professional dental companies can provide comprehensive dental eligibility verification services to verify the patient’s coverage before procedures are performed.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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