Is flap surgery included in D4263?

No, flap surgery is not included and should be billed separately if performed.

Can D4263 be used for an extraction site?

No, D4263 is not applicable for extraction sites or edentulous spaces.

What documentation is needed for insurance claims with D4263?

Ensure you have periodontal charting, radiographic evidence, and detailed clinical notes to support the necessity of the procedure.

Are there any frequency limitations for using D4263?

Frequency limitations may vary by insurance provider, so it's important to check with the specific payer for their guidelines.

D4263

Bone Replacement Graft - CDT Code Guide

Periodontics/Surgical Services (Including Usual Postoperative Care)

Overview

CDT Code D4263 is designated for the bone replacement graft procedure for retained natural teeth, specifically the first site in a quadrant. This procedure is crucial in periodontal therapy, aimed at regenerating bone lost due to periodontal disease. It involves placing a graft material to stimulate new bone growth, which is essential for maintaining tooth stability and function. This procedure is typically employed when periodontal disease has caused significant bone deformity around a tooth, necessitating intervention to restore the bone structure. It's important to note that this code does not cover additional procedures such as flap entry, closure, or the use of biologic materials, which must be billed separately.

When to Use This Code

When a patient has periodontal disease that has resulted in bone loss around a natural tooth.
In cases where bone deformity around a tooth is affecting its stability.
When periodontal regeneration is necessary to preserve a natural tooth.
For the first site in a quadrant requiring a bone graft.
When a patient is not undergoing tooth extraction or dealing with an edentulous space.

Documentation Requirements

Detailed periodontal charting indicating bone loss.
Radiographic evidence supporting the need for a bone graft.
Clinical notes describing the periodontal condition and treatment plan.
Documentation of the graft material used and the site of placement.
Patient consent forms for the procedure.
Post-operative care instructions provided to the patient.

Billing Considerations

When billing for D4263, it's important to note that this code is specific to the first site in a quadrant and should not be used for edentulous spaces or extraction sites. Ensure that any additional procedures such as flap surgery or use of biologic materials are billed separately under their respective codes. Be aware of payer-specific guidelines, as some insurance plans may have frequency limitations or require prior authorization for periodontal procedures.

Related CDT Codes

D4264 D4266 D4267 D4268 D4270

Frequently Asked Questions

No, D4263 is specifically for the first site in a quadrant. Additional sites should be billed using the appropriate codes.

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