Can D4999 be used for routine periodontal maintenance?

No, D4999 is not intended for routine procedures like periodontal maintenance, which have specific codes such as D4910.

How do insurance companies handle claims with D4999?

Insurance companies may require additional documentation and justification for claims using D4999, as it is an unspecified code.

Is pre-authorization required for procedures billed under D4999?

Pre-authorization may be required depending on the insurance policy, so it's important to verify with the insurer beforehand.

Can D4999 be used for cosmetic periodontal procedures?

D4999 is generally not used for cosmetic procedures unless there is a medical necessity that is well-documented and justified.

D4999

Unspecified Periodontal Procedure - CDT Code Guide

Periodontics/Other Periodontal Services

Overview

CDT code D4999 is designated for periodontal procedures that do not have a specific code. This code is used when a dental procedure is performed that falls outside the scope of existing codes in the periodontal category. Typically, this involves unique or rare procedures tailored to a patient's specific needs. Dental professionals must provide a detailed report describing the procedure, its necessity, and the expected outcomes. This ensures clarity and justification for the treatment provided, particularly when dealing with complex periodontal cases that require customized solutions.

When to Use This Code

When performing a unique periodontal surgery not covered by existing codes.
For experimental or innovative periodontal treatments.
In cases where a combination of procedures is performed that cannot be individually coded.
When dealing with rare periodontal conditions requiring specialized intervention.
For procedures involving advanced technology or techniques not yet standardized.

Documentation Requirements

A detailed report describing the procedure performed.
Clinical notes explaining the necessity of the procedure.
Pre- and post-operative photographs or radiographs, if applicable.
Patient consent forms for the procedure.
A summary of expected outcomes and follow-up care plans.

Billing Considerations

When billing with D4999, it is crucial to provide comprehensive documentation to justify the use of this unspecified code. Insurance carriers may require additional information to process claims, and coverage may vary. Be aware of any frequency limitations imposed by the insurance provider. Common modifiers may include those indicating a distinct procedural service or multiple procedures performed on the same day.

Related CDT Codes

D0150 D0180 D4210 D4341 D4910

Frequently Asked Questions

The report should include a detailed description of the procedure, the clinical rationale, and any supporting documentation such as images or patient history.

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