Can D4212 be billed with other periodontal procedures?

Yes, D4212 can be billed alongside other periodontal procedures, but ensure proper documentation and use of modifiers to avoid claim issues.

What is the difference between gingivectomy and gingivoplasty?

A gingivectomy involves the removal of gum tissue, while gingivoplasty reshapes the gums. Both can be used for restorative access under D4212.

How should I document the need for D4212?

Document the clinical necessity, including any obstruction to restorative work, and include pre- and post-operative photographs.

Are there any post-operative care considerations for D4212?

Yes, post-operative care includes monitoring for infection, ensuring proper healing, and maintaining periodontal health to support restorative success.

D4212

Gingivectomy for Restorative Access - CDT Code Guide

Periodontics/Surgical Services (Including Usual Postoperative Care)

Overview

CDT Code D4212 refers to a gingivectomy or gingivoplasty procedure performed to allow for restorative access, per tooth. This surgical service is part of the periodontics category and involves the removal or reshaping of gum tissue to provide better access for restorative dental procedures. Typically, this procedure is necessary when excess gum tissue obstructs the dentist's ability to properly restore a tooth, such as placing a crown or filling. It is crucial for ensuring the longevity and success of the restorative work by providing a clean and accessible area for treatment. Dental professionals often perform this procedure in cases where periodontal health is compromised, or when aesthetic improvements are needed.

When to Use This Code

When excess gingival tissue prevents proper crown placement.
To improve access for cavity restoration on a tooth with subgingival decay.
In cases where gingival overgrowth affects the fit of dental prosthetics.
When periodontal health needs to be improved before restorative work.
To enhance the aesthetic outcome of anterior restorations.

Documentation Requirements

Detailed clinical notes describing the need for the procedure.
Pre-operative and post-operative photographs of the treatment area.
Patient consent forms indicating awareness of the surgical procedure.
Documentation of periodontal health status before and after the procedure.
A treatment plan outlining the restorative work to follow the gingivectomy.
Insurance verification and pre-authorization if required.

Billing Considerations

When billing for D4212, it is important to note any frequency limitations imposed by insurance carriers, as this procedure may not be covered if performed too frequently. Common modifiers include those indicating multiple procedures or bilateral services. Ensure that the procedure is documented as medically necessary for restorative access to increase the likelihood of insurance coverage. Coordination with insurance for pre-authorization can prevent claim denials.

Related CDT Codes

D4249 D4260 D4261 D4341 D4342

Frequently Asked Questions

Coverage for D4212 varies by insurance plan. It's often covered when deemed medically necessary for restorative access, but pre-authorization may be required.

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