Augmentation of bony defects due to loss of teeth using bone-grafting materials is a common procedure performed by general dentists, periodontists and oral surgeons. When billing bone grafts, it is necessary to use the most up-to-date codes, while avoiding unlisted, unspecified and nonspecific codes. In addition to selecting the right CDT code, dentists have to also report the correct ICD-10 code to indicate the diagnosis. Further, as medical insurance reimburses for oral surgeries, with knowledge about cross-coding, dental offices save dental insurance and help patients get needed treatment. Working with an experienced dental billing company is a practical strategy for dentists to manage the billing and coding process and maximize reimbursement.
When Bone Grafting is Necessary
Bone grafts are used in combination with endodontic, oral surgery, implants and periodontal procedures. Bone loss in the jaw due to loss of teeth can cause atrophy of remaining alveolar bone, leading to chewing and speech problems, soft-tissue pain, muscle dysfunction, and lack of bone for tooth implants. Bone grafting is usually performed in the following situations:
After tooth extraction to limit the amount of hard- and soft-tissue loss
Before dental implant surgery to replace a lost tooth
To build the jaw before dental implant placement
When bone loss affects neighboring teeth
For reducing bone loss caused by periodontal disease
To correct trauma or surgery defects
General alveolar deterioration
There are various types of bone grafting material options:
Autogenous – the tissue is taken from the patient undergoing the graft procedure
Non-autogenous: the graft is taken from donor other than the patient (allogenic, alloplastic, allograft and xenograft materials)
After the procedure, the bone graft will support bone healing and regeneration, and add volume and density to the jaw.
CDT Codes for Bone Grafts
The CDT codes for graft procedures are found in the Endodontics, Periodontics, Implant service and Oral & Maxillofacial surgery service categories. Dentists need to report the correct CDT code to describe the grafting procedure that the patient underwent.
The CDT codes for bone grafts are as follows
Bone Graft for Endo/Periradicular Defects
D3428 Bone Graft in Conjunction with Periradicular Surgery – per tooth, single site (includes non-autogenous graft material)
D3429 Bone Graft in Conjunction with Periradicular Surgery – each add’l contiguous tooth in same surgical site (includes non-autogenous graft material)
Bone Graft for Periodontal Defects
D4263 Bone replacement graft – retained natural tooth – first site in quadrant
D4264 Bone replacement graft – retained natural tooth – each additional site in quadrant
Bone Graft for Periimplant Defects
D6103 Bone Graft for Repair of Periimplant Defect
Note: This is for grafting a bone defect around an existing implant, and does not include flap entry and closure. Placement of a barrier membrane or biologic materials to aid in osseous regeneration should be reported separately.
Bone Graft When Placing Implant
D6104, Bone Graft at Time of Implant Placement
Note: This is for bone grafting around an implant at the same time the implant is placed. The placement of a barrier membrane, or biological materials to aid in osseous regeneration is reported separately.
Bone Graft for Ridge Augmentation in Edentulous Site
D7950 Osseous, Osteoperiosteal, or Cartilage Graft of the Mandible or Maxilla – Autogenous or Nonautogenous, By Report
Note: It includes obtaining autograft and/or allograft material. Placement of a barrier membrane, if used, should be reported separately. This is not a graft done in an extraction site or implant removal site.
Reporting Graft Material Acquisition
There are CDT Codes with descriptions that state that:
the procedure includes graft material acquisition
the graft material is acquired as a separate procedure and reported with the appropriate code
➤ Procedures where Material Acquisition and Graft Placement are separate
Graft Procedures Not including Obtaining Graft Material – The following CDT codes explicitly state that the procedure does not include harvesting or collecting the graft material:
D7950 Bone Replacement Graft for Ridge Preservation – per site
CDT descriptor: “Osseous autograft, allograft or non-osseous graft is placed in an extraction or implant removal site at the time of the extraction or removal to preserve ridge integrity (e.g., clinically indicated in preparation for implant reconstruction or where the alveolar contour is critical to planned prosthetic reconstruction).”
Note: This dental bone graft code can be used when filling in the hole after the removal of a tooth or dental implant. It does not include obtaining graft material. If a membrane is used, it should be reported separately.
D7955 Repair of Maxillofacial Soft Tissue and/or Hard Tissue Defect
Note: Reconstruction of surgical traumatic or congenital defects of the facial bones, including the mandible, may utilize graft materials in conjunction with soft tissue procedures to repair and restore the facial bones to form and function. This procedure does not include edentulous maxilla and mandibular reconstructions for prosthetic considerations
➤ CDT Code for Graft Material Collection Only
D7295 Harvest of Bone for Use in Autogenous Grafting Procedures
Note: D7295 is the only code entry specifically for reporting acquisition of material used in a separate graft procedure. It is reported when hard tissue (bone) is collected from the patient who is also to receive the separate bone graft procedure.
➤ Graft Procedures that Include Material Acquisition
Graft Procedures including Graft Material Acquisition
There are 13 CDT codes for procedures where the descriptor states that the acquisition of the graft material is included and not to be reported as a separate procedure in a claim. For e.g., the following procedures include graft material acquisition in general terms:
D4277 Free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant or edentulous tooth position in graft
D4278 Free soft tissue graft procedure (including recipient and donor surgical sites) each additional contiguous tooth, implant or edentulous tooth position in same graft site
D7943 Osteotomy – mandibular rami with bone graft; includes obtaining the graft
D7951 Sinus augmentation with bone or bone substitutes [The augmentation of the sinus cavity to increase alveolar height for the reconstruction of edentulous portions of the maxilla. This includes obtaining bone or bone substitutes. Placement of a barrier membrane, if used, should be reported separately].
D7952 Sinus augmentation via a vertical approach
With the multiple CDT codes involved, documentation of graft procedures can be confusing. Insurance companies will reimburse bone grafts only if they are medically necessary for the success of the procedure being performed or when normal healing cannot be expected to eliminate the bony defect (www.aetna.com). Further, dental insurance verification is necessary to understand patient coverage as each benefit plan has different rules as to which services are covered, which are excluded and which have dollar caps or other limitations. Therefore, it is recommended that the practice sends out a pre-treatment authorization to ensure a smooth claim determination process. Partnering with an experienced provider of dental billing services is the best way to meet these requirements.
Frenectomy procedures are performed primarily on infants, and it involves the removal of one or both frena from the mouth. As per the statistics given by the American Academy of Pediatric Dentistry, the number of frenotomy/frenectomy procedures performed is growing with a 90 percent increase in recent years. As the ADA (American Dental Association) changes the CDT (Current Dental Terminology) codes frequently, dental practices are required to adopt the changes and ensure accuracy in their claims. A dental billing company can help with complete and accurate documentation of dental procedures.
Frenectomy – A Covered Dental Procedure;
Frenectomy is considered medical in nature due to the following two reasons:
There is a problem feeding the newborns
It is required to correct congenital malformation( Ankyloglossia)
It implies that a frenectomy is medically necessary and is accompanied by the following symptoms, according to provcomm.ibx.com:
Difficulty feeding/eating
Difficulty chewing ( mastication)
Difficulty swallowing
Speech impairment or difficulty with articulation
The procedures used to treat the lingual frenum (other than for ankyloglossia), the labial frenum and the buccal frenum are considered dental procedures. Dental practices have to take note of the fact that they are not covered under medical plans and are considered benefit contract exclusions.
CPT Codes for Frenectomy or Frenotomy
41010
In this procedure, the provider makes an incision in the lingual frenum, a membranous ridge under the tongue, to allow greater movement of the tongue in patients with ankyloglossia.
41115
In this procedure, the provider makes an incision at the base of the tongue and excises the frenum.;
40806
The provider incises the labial frenum, the tag of tissue in the center of the upper or the lower lip that attaches the lip to the gums of the patient. The provider does not remove the frenum. The provider commonly performs this procedure to release a tight frenum and its surrounding tissues.
40819
In this procedure, the provider removes the labial or buccal frenum, each of which is a membrane structure in the mouth. Labial refers to the lip and buccal refers to the cheek.
41115
In this procedure, the provider makes an incision at the base of the tongue and excises the frenum.
ICD-10 Codes
Q38.1
Ankyloglossia
For feeding difficulties:
R63.3 – Feeding difficulties
P92.5- Neonatal difficulty in feeding at the breast
P92.8- Other feeding problems of newborn
P92.9- Feeding problem of newborn, unspecified
For childhood articulation problems:
F80.0- Phonological disorder
F80.89-Other developmental disorders of speech and language
F80.9- Developmental disorder of speech and language, unspecified
CDT Codes
The below-mentioned codes are newly added CDT codes and are effective from 01/01/2021.
D7961- Buccal / labial frenectomy (frenulectomy)
D7962- Lingual frenectomy ( frenulectomy)
Guidelines to Follow While Claiming Dental Insurance
To facilitate coverage and payment, submitting the claim with x-rays alone is insufficient.
The above-mentioned codes are applicable only if the procedure involves removing a patient’s frenum.
Carefully consider the patient’s plan limitations and exclusions.
The claims of this procedure are limited to once per lifetime, per tooth.
If connective tissue graft or pedicle graft is reported on the same visit as the frenectomy, the frenectomy is considered inclusive with no additional payments.
According to dentistryiq.com, a narrative should also be included which indicates the following:
Amount of gingival recession in millimetres
The severity of gingival inflammation
The level of sensitivity
Bleeding on probing
The claim form should be accompanied by pre-op and post-op x-rays in addition to periodontal charting.
General Guidelines for Medical Billing for Dental Surgery
According to dentalproductsreport.com, to successfully place dental claims, the following has to be accurately documented:
The primary presenting situation
Any secondary, supporting diagnosis
The diagnosis code for the treatment
Surgical pre-authorization
Medical necessity, in the form of a letter of medical necessity
Support from the patient’s primary care physician, in the form of a supporting letter of medical necessity
The procedures performed at each surgery location
This is vital information that is required by the medical insurance company to get a comprehensive understanding of the care provided.
Prior-authorization
Frenectomy procedures require a pre-authorization. The insurer has to be contacted via phone to explain the procedure and the date. Reimbursement claims will be rejected if pre-authorization is not obtained.
Verification of insurance
Dental eligibility verification is essential to gather information about the coverage for this surgery. The following information must be collected from the patients first:
Name of the primary insured
Social security number of the primary insured
Insurance carrier
ID number
Group number
Contact details of the insurance company like phone number, web address and residential address for submitting claims.
Proving medical necessity
A frenectomy is performed as a medically necessary procedure. Accurate medical coding is vital. Coding should inform the payer that the procedure was performed and the reason that the patient’s concern was medical rather than just a dental problem
Accurate coding
Appropriate ICD-10 codes and CPT codes have to be incorporated in the Letter of Medical Necessity. According to Dental Practice Management, dental practices have to limit themselves to entering only four diagnostic codes in the Letter of Medical Necessity. The most important procedure should be listed first, followed by the procedures of a lesser importance.
Documenting and submitting the claims
After the dental surgery, the next important step is filling in the claims submission form correctly. A thorough look over the forms is necessary to identify typos or missed information. The claim must be submitted to the insurer with appropriate documentation. Lab or diagnostic imaging studies are also to be submitted along with the claims as supporting documents.
Compared to billing for other medical specialities, dental billing is complex. An experienced dental billing company can help dental practices to improve dental billing collections and ROI, particularly for services like frenectomies where prior authorization is required.
Periodontal diseases need to be treated on time to prevent any infection. If non-surgical treatment options fail, dentists may recommend surgical periodontic procedures to prevent future gum damage, remove bacteria from beneath the gums, and reshape the bones that support the teeth. Periodontal surgery comprises several procedures such as gingival flap surgery, mucogingival surgery, and osseous surgery. Dental practices can report such procedures on insurance claims using specific CDT and ICD-10 codes. Consider partnering with a professional dental billing company that can provide support in submitting clean dental claims.
CDT Codes for Surgical Periodontic Procedures
Gingivectomy
Gingivectomy refers to the surgical removal of gingival or gum tissue. The procedure is mainly done to treat gingivitis and for cosmetic purposes. The surgery involves removing a portion of the gums around a tooth or teeth, which can lengthen the height or width of a tooth or a section of teeth.
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 to restorative procedure, per tooth
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
D4346 scaling in presence of generalized moderate or severe gingival inflammation- full mouth, after oral evaluation
D4921 gingival irrigation- per quadrant
D7971 excision of per coronal gingival
Dental Crown Lengthening
For better oral hygiene and comfort, dental crowns need to be properly fixed. A dental crown lengthening procedure helps correct excess gum tissue covering the teeth. The procedure is performed by recontouring gum tissue or bone, which exposes more of a tooth’s surface for a crown.
D4249 Clinical crown lengthening – hard tissue
Osseous Surgery
This surgery is performed to manage the destruction caused by periodontal gum disease. Subtypes of osseous surgery include the bone reshaping or resectioning procedures and bone stimulative procedures. While osteotomy can reshape bones, osteotomy can correct bone defects and create normal bone contours.
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
Mesial/Distal Wedge
This surgical procedure is done following the extraction of a wisdom tooth. It helps to remove the additional tissue that is covering a portion of the back teeth in the gap left by the wisdom tooth. This surgery involves numbing the area using local anaesthesia and removing a small wedge of tissue and suturing the surgical wounds with stitches.
D4274 Mesial/distal wedge procedure, a single tooth (when not performed in conjunction with surgical procedures in the same anatomical area)
D4999 Unspecified periodontal procedure, by a report
Anatomical Crown exposure
Anatomical crown exposure is recommended for uneven gum lines and for teeth appearing too short. Here, the excess gum and tissue are removed and the gum line is then sculpted to create a correct proportion between gum tissue and tooth surface.
D4230 Anatomical Crown Exposure four or more contiguous teeth
D4231 Anatomical Crown Exposure one to three contiguous teeth
D4268 Surgical Revision Procedure per tooth
Regeneration
During the regeneration periodontal surgical procedure, the periodontist folds back the gum tissue to eliminate bacteria. It helps in completely restoring the lost tissues. Even after the procedure, there are chances for epithelial, gingival connective tissue or bone to grow along the root surface.
D4265 Biologic materials to aid in soft and osseous tissue regeneration
Soft Tissue Grafting
A gum graft is recommended to protect the teeth from the damaging effects of gum recession or to improve the appearance of the smile. Three different types of gum tissue grafts are connective-tissue grafts, free gingival grafts, and Pedicle grafts.
D4270 Pedicle soft tissue graft procedure
Related ICD-10 codes
C03 Malignant neoplasm of gum
C03.0 Malignant neoplasm of upper gum
C03.1 Malignant neoplasm of lower gum
C03.9 Malignant neoplasm of gum, unspecified
D00.00 Carcinoma in situ of the oral cavity, unspecified site
D10.39 Benign neoplasm of other parts of the mouth
K05 Gingivitis and periodontal diseases
K05.0 Acute gingivitis
K05.1 Chronic gingivitis
K05.2 Aggressive periodontitis
K05.3 Chronic periodontitis
K05.4 Periodontosis
K05.5 Other periodontal diseases
K05.6 Periodontal disease, unspecified
K06 Other disorders of gingiva and edentulous alveolar ridge
K06.0 Gingival recession
K06.1 Gingival enlargement
K06.2 Gingival and edentulous alveolar ridge lesions associated with trauma
K06.3 Horizontal alveolar bone loss
K06.8 Other specified disorders of gingiva and edentulous alveolar ridge
K06.9 Disorder of gingiva and edentulous alveolar ridge, unspecified
Choosing the right dental or diagnosis codes for these periodontal surgeries require good knowledge of the changing coding and billing standards. Professional dental billing companies can take care of the time-consuming dental insurance eligibility verification tasks, and thus ensure the smooth flow of revenue for the services provided.
If your dental practice accepts insurance, implementing a streamlined dental insurance verification process is one of the most important steps to ensure a smooth patient experience and getting paid for services rendered. In fact, insurance verification is the first step in the patient intake and dental billing process.
Insurance verification involves verifying information related to the patient’s insurance eligibility and benefits. Checking the patient’s active coverage and determining their responsibility is crucial to file accurate claims and avoid denials due to patient ineligibility. With multiple insurance plans and fee schedules, staying up to date with patient benefits can be a major hassle. There are two ways to go about it:
Have a dedicated dental insurance verification specialist do it manually
Use automated dental insurance software
Digitizing dental eligibility verification using software is widely touted for benefits such as availability of up-to-the-minute real time information, reduced delays, prevention of errors, and more. But how reliable is the process? Our research found that verifying insurance verification through a software program is not the best approach. Let’s first see how the automated option works:
A dental insurance verification platform integrates with the practice management system and digitizes the entire process. Typical features include:
Accesses the daily patient schedule several days in advance of the appointment
Automatically pre-populates patient information from the dental management system
Allows patients to complete their insurance forms and other paperwork from any location before their appointment
Digitally processes patient eligibility and payment and insurance information immediately with just a few clicks of a button
Reduces time patients spend in the waiting room
Completes all verifications for the day in a matter of seconds
Integrates with many commercial and government insurance payers
However, experience shows that using insurance verification software can lead to inaccuracies and inefficiencies. Here are some major concerns voiced by dental offices using these platforms:
Software verifications typically only provide about 70% of the information you need. The office staff has to find the rest on their own.
Only limited information may be available depending on which insurance company you are checking with. Some systems provide more data than others and don’t attempt different ways to obtain more information.
Automated platforms do not customize their forms. They offer standard forms that are only checked within their format and guidelines. If the provider needs to check extra codes, they must do this on their own.
They only provide a PDF with the benefit information retrieved. Automated systems do not update the coverage tables in the provider’s software.
They do not always provide accurate information on stipulations with certain procedures and waiting periods. The office staff has to rely on manual phones to find this information.
Eligibility information is not detailed and does not provide the requisites when it comes to periodontics or prosthetics work.
With all these limitations, it’s clear that an automated insurance verification system cannot provide all the details the dental office requires to bill patients.
Manually filling out the in-office insurance verification form is the most comprehensive way to check each patient’s status of coverage, benefits, deductibles, annual benefits limitations, maximums, co-insurance, preauthorizations, and more. Dental insurance is complex and most patients do not understand its coverage and benefits. Outsourcing dental verification to an experienced dental billing company can ensure that your office has a dedicated dental expert working is on verifications and authorizations to provide a full breakdown of individual insurance benefits – which dental procedures are covered benefits, percentage coverage for each procedure, if any benefits were already used elsewhere, what is the patient’s plan maximum, and more. Details verified before services are provided to each patient include, but are not limited to:
Annual maximum, including premiums, co-pays, and deductibles
Out-of-pocket limit (if any)
Limitations on pre-existing conditions
Coverage for braces
Routine and major dental treatment covered
Whether the plan covers diagnostic, preventive, and emergency treatment and how much
Who is eligible for coverage under the plan
Primary and secondary insurance
When coverage goes into effect
Preauthorizations
In addition to accessing the insurance company’s website to obtain the required information, and insurance verification specialist will make calls to the company to seek clarifications, provide financial counselling assistance to patients before their restorative procedures, and also help with payroll and billing. Overall, outsourcing insurance verification and authorization streamlines the process, saves your staff’s time, ensures accurate information for claims filing, and prevents denials due to eligibility errors.
Bottom line: dental insurance verification is something humans can definitely do better than software.
It is necessary to document each component of dental implant services to ensure the highest possible reimbursement. In addition, accurate documentation is also vital from the point of view of ongoing patient care. Implant procedures that meet the threshold of medical necessity are eligible for medical billing. A reputable dental billing company can appropriately code CDT codes during claims submission, based on the insurance availed.
CDT Codes That Represent Dental Implant Services
D6190
Radiographic/surgical implant index, by the report
D6191
Semi-precision abutment –placement
D6192
Semi-precision attachment-placement
Surgical Implant Procedure Codes
D6010
Surgical placement of implant body: endosteal implant
D6011
Second stage implant surgery
D6012
Surgical placement of interim implant body for transitional prosthesis: endosteal implant
D6013
Surgical placement of mini implant
D6040
Surgical placement: eposteal implant
D6050
Surgical placement: transosteal implant
D6100
Implant removal, by report
D6101
Debridement of a peri-implant defect or defects surrounding a single implant, and surface cleaning of the exposed implant surfaces, including flap entry and closure
D6102
Debridement of the osseous contouring of a peri-implant defect or defects surrounding a single implant and includes surface cleaning of the exposed implant surfaces including flap entry and closure
D6103
Bone graft for repair of peri-implant defect does not include flap entry and closure
D6104
Bone graft at the time of implant placement
Implant Supported Prosthetics
D6055
Connecting bar-implant supported or abutment supported
D6056
Prefabricated abutment-includes modification and placement
D6057
Custom fabricated abutment-includes placement
D6051
Interim abutment
D6052
Semi- precision attachment abutment
Implant/ Abutment Supported Removable Dentures
D6110
Implant/ abutment supported removable denture for edentulous arch-maxillary
D6111
Implant/ abutment supported removable denture for edentulous arch-mandibular
Implant supported retainer for FPD-porcelain fused to high noble alloys
D6098
Implant supported retainer-porcelain fused to predominantly base alloys
D6099
Implant supported retainer for FPD-porcelain fused to noble alloys
D6120
Implant supported retainer-porcelain fused to titanium and titanium alloys
D6077
Implant supported retainer for metal FPD-high noble alloys
D6121
Implant supported retainer for metal FPD-predominantly base alloys
D6122
Implant supported retainer for metal FPD-noble alloys
D6123
Implant supported retainer for metal FPD-titanium and titanium alloys
Other Implant Services
D6080
Implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prostheses and abutments
D6081
Scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant services, without flap entry and closure
D6085
Provisional implant crown
D6090
Repair implant supported prosthesis, by report
D6091
Replacement of semi-precision or precision attachment (male of female component) or implant /abutment supported prosthesis, per attachment
D6092
Re-cement or re-bond implant/abutment supported crown
D6093
Re-cement or re-bond implant/abutment supported fixed partial denture
D6095
Repair implant abutment, by report
D6096
Remove broken implant retaining screw
D6199
Unspecified implant procedure, by report
Dental practices must keep up to date with the CDT codes and their changes in order to file the claims correctly. To maintain consistent revenue flow, save time, and deliver excellent patient care, dentists and dental practices should consider utilizing outsourced dental billing services.
