Your SlideShare is downloading. ×
Perio gp
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Perio gp

779
views

Published on

Integrating Periodontics …

Integrating Periodontics
Into the General Practice

Published in: Health & Medicine, Education

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
779
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
14
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Dr. Bashar Bakdash Periodontology IIISpring Semester, 2012 School of DentistryUniversity of Minnesota Course and Faculty Evaluation By Dental Hygiene Students Percentage of Individuals Over 65 Who Reported Having Most of Their Natural Teeth* *Lost 5 teeth or less-CDC 2002 1 of 11 24
  • 2. Dr. Bashar Bakdash Periodontology III Spring Semester, 2012 School of Dentistry University of MinnesotaPercentage of Individuals 65 Years & Older Who United State Population 65 Years of Age and Over:1950-2030 Reported Having Most of Their Natural Teeth* 46.8 59.4 48.9 54.2 50.2 *Lost 5 teeth or less-CDC 2002 Data Percentage of Independent Dentists Employing Dental Hygienists 0 1 2 3+ Number of full and part-time hygienists Source: American Dental Association, Survey Center, 2005 Survey of Dental Practice 2 of 11 24
  • 3. Dr. Bashar Bakdash Periodontology III Spring Semester, 2012 School of Dentistry University of Minnesota Average number of patients seen weekly per dental hygienist in the primary private practice of independent dentists, 2000-2004Number of Weekly Patients Year Source: American Dental Association, Survey Center, Surveys of Dental Practice 3 of 11 24
  • 4. Dr. Bashar Bakdash Periodontology III Spring Semester, 2012 School of Dentistry University of Minnesota Integrating Periodontics Dental Team Involvement Into the General Practice !Analysis of the dental team: !!!!!""!- Desire and motivation to make the transformation Dental team involvement - The role of each member of the teamEducational and clinical considerations !Analysis of the practice style: - Willingness to critically analysis the exiting practice - Commitment to invest time, energy and funds requiredEducational and Clinical Considerations! Didactic and clinical education and updates! Record keeping and quality assurance! Instruments and equipment needed! Recall system! Referral philosophy and process! Dealing with exiting and new patients 4 of 11 24
  • 5. Dr. Bashar Bakdash Periodontology III Spring Semester, 2012 School of Dentistry University of Minnesota Periodontal Treatment Protocol (PTP) Classification of Periodontal Diseases! Gingival Diseases! Chronic Periodontitis! Aggressive Periodontitis! Periodontitis as a Manifestation of Systemic Diseases! Necrotizing Periodontal Diseases! Abscesses of the Periodontium! Periodontitis Associated with Endodontic Lesions! Developmental or Acquired Deformities and ConditionsPeriodontal Treatment Protocol (PTP) Periodontal Patient Referral Visit 1 Sample Visit 2 Scripts ! Developing strong relationships with general practitioners ! Developing the dental hygienist as a referral source Billing Codes Visit 3 Procedures Forms Patient Referral Literature 5 of 11 24
  • 6. Dr. Bashar Bakdash Periodontology III Spring Semester, 2012 School of Dentistry University of MinnesotaProfessional Partnership Programs 6 of 11 24
  • 7. Dr. Bashar Bakdash Periodontology III Spring Semester, 2012 School of Dentistry University of Minnesota Conclusion" This study indicates that four demographic!!!variables have statistical influence on the!!!number of referrals per month from a general!!!practitioner to a periodontist." These variables are: female gender, practicing!!!with one other dentist, employing two or more!!!hygienists, and being more than 5 miles away!!!from the nearest periodontist. Periodontal Patient Referral #When in doubt, seek periodontal consultation !!!!and/or a second opinion #Provide information relevant to: 1. Chief concerns as expressed by the patient and therapist !!!! 2. Health status and the need for special consideration 3. Any past experience with periodontal treatment 4. Anticipated dental therapeutic procedures 5. A quality full-mouth set of radiographs Periodontal Patient Referral Periodontal Patient Referral #The majority of patients with:#Expect to receive back from the periodontist: - Early (1-2 mm of CAL)!! !1. Periodontal diagnosis and prognosis !!!!- Moderate (3-4 mm of CAL) 2. Proposed periodontal treatment plan and possible alternatives !!!chronic periodontitis that are diagnosed early can be typically treated and maintained in the general practice !3. Needs for coordinated treatments, including but not limited to !endontic, !!! TMD, orthodontic, oral surgery, restorative,!prosthetic reconstruction !! with!or without implants and the recommended schedule for periodontal !!!!maintenance!!!!!4. Patient interest and willingness to accept and follow-up on!the !proposed !!! periodontal!treatment 7 of 11 24
  • 8. Dr. Bashar Bakdash Periodontology III Spring Semester, 2012 School of Dentistry University of Minnesota Periodontal Patient Referral Periodontal Patient Referral#Aggressive forms of periodontitis: #Advanced (more than 5 mm of CAL) chronic periodontitis with sites depict either: - Localized or generalized periodontitis in Children or !!!!adolescents -Progressive deepening of pockets with CAL and/or!bone - Individuals 30 years of age and older with significant !!!loss as seen on radiographs !!!bone loss (over 4mm or 1/3 of the root length) -Infrabony defects that have the potential for !!!!!regenerative therapy - Multiple-rooted teeth with more than 4 mm of CAL with !!!furcation involvements that will complicate therapy - Mucogingival defects that exhibit progressive recession !!!!and/or are of an esthetic concern Periodontal Patient Referral Periodontal Patient Referral#Other clinical situations such as: # Other clinical situations such as: - Comprehensive periodontal appraisal prior to initiating !!!!- Mucogingival defects that exhibit progressive recession !!!orthodontic or extensive restorative therapy in adults !!and/or are of an esthetic concern!!!!- Atypical periodontal diseases associated with immune !!!!- Tooth/teeth extraction in conjunction with ridge !!!response or systemic health !!!preservation!or augmentation - Excision of proliferating or excessive gingival tissues - Exposure of impacted teeth in conjunction with - Crown lengthening surgery as indicated for restorative !!!orthodontic treatment !!!and/or esthetics purposes !!!!- Surgical placement of root-formed dental implants Conclusion " The main reason for non-compliance was that !! the patients did attend their own dentist !!!exclusively for maintenance therapy. " Tooth loss and periodontal deterioration was !!!more marked in this group than patients who !!!in addition attended the specialist office for !!!maintenance therapy. 8 of 11 24
  • 9. Dr. Bashar Bakdash Periodontology III Spring Semester, 2012 School of Dentistry University of Minnesota Dental Insurance U. S. Expenditure on Health Care Reporting In DIAGNOSTIC CONDITION U.S. EXPENDITURE Periodontics Heart Conditions…………….. 90 Billion Oral Health Conditions……… 71 Billion Cancer……………………….. 62 Billion Trauma - Related Disorders….. 58 Billion Mental Disorders…………….. 52 Billion COPD, Asthma………………. 49 Billion Source: Agency for Healthcare Research and Quality Medical Expenditures Panel Survey, 2004Dental Expenditures (in Billions of $) by "Selected Calendar Year 1970-2008 Percentage of Patients Covered Under a Dental Insurance Plan " Only 6-7% of all insured patients reach their yearly maximum " the average total expenditure per insured is less than $400 No 40% Yes 60%Source: Waldman HB: Favorable dental economics could belie coming crisis. Calif Dent Assoc J 29:839-845, 2001 Source: American Dental Association, Survey Center, 2000 Public Opinion Survey 9 of 11 24
  • 10. Dr. Bashar Bakdash Periodontology III Spring Semester, 2012 School of Dentistry University of MinnesotaDistribution of Dental Insurance Benefit Dollars Periodontal Procedures & Dental Insurance Benefit Dollars Among Various Areas of Dentistry About 50% performed by non-periodontists Background Information Background Information ! Dental benefits plans vary greatly from carrier to carrier ! Many carriers created contracts based on previous ! Not all carriers are legally required to adhere to the CDT codes, and until these contracts expire, they American Dental standard. While in many states there will not change over to the new CDT codes are statutory provisions that designate the American ! Insurance carriers typically have large in house Dental Association as the standard for dental carriers, computer systems that are complex and may take not-for-profit carriers (such as Delta and Blue Cross) time to re-program them are not governed by such provisions 10 of 11 24
  • 11. Dr. Bashar Bakdash Periodontology III Spring Semester, 2012 School of Dentistry University of Minnesota Insurance Coding and Communication Tips ! Dentist Vs dental hygienist provided services ! Determine the overall medical, oral, dental and periodontal status ! Use appropriate CDT codes regardless of the patient insurance ! Clinical evaluation codes ! Preventive codes ! Non-surgical codes ! Surgical codes Colgate Oral Care Report, Volume 16, Number 4, 2006 ! Implant codes 2003 AAP Workshop on Contemporary Science in Clinical PeriodonticsThe leadership Curve shows the leadership level requiredand the horizontal axis shows the clinical range of clinical care that will be provided. Clinical, Organizational and relshioship skills are also illustrated 11 of 11 24
  • 12. Periodontal Insurance Reporting Dr. Bashar Bakdash Division of PeriodontologyDepartment of Developmental and Surgical Sciences School of Dentistry University of Minnesota 12 of 24
  • 13. Classification of Gingival and Periodontal Diseases*Gingival Diseases-Plaque-induced gingival diseases-Non-plaque-induced gingival lesionsChronic Periodontitis-Localized-GeneralizedAggressive Periodontitis-Localized-Generalized Periodontitis as a Manifestation of Systemic Diseases Necrotizing Periodontal Diseases-Necrotizing ulcerative gingivitis (NUG)-Necrotizing ulcerative periodontitis (NUP)Abscesses of the Periodontium-Gingival abscess-Periodontal abscess-Pericoronal abscessPeriodontitis Associated with Endodontic Lesions-Endodontic-periodontal lesion-Periodontal-endodontic lesion-Combined lesionDevelopmental or Acquired Deformities and Conditions-Localized tooth-related factors that predispose to plaque-induced gingival diseases or periodontitis-Mucogingival deformities and conditions around teeth-Mucogingival deformities and conditions on edentulous ridges-Occlusal trauma* Adapted from: Armitage GC: Development of a Classification System for Periodontal Diseases and Conditions, Ann Periodontol 4:1, 1999. 13 of 24 1
  • 14. OverviewIn late 2008 the American Dental Association published the CDT-2009/2010 of the Code onDental Procedures and Nomenclature. The fact that codes are published does not mean that theprocedure(s) is/are accepted/reimbursable in a given dental benefits plan or by each individualcarrier. There are several factors contributing to these issues:1. Dental benefits plans vary greatly from carrier to carrier.2. Not all carriers are legally required to adhere to the American Dental standard. While in many states there are statutory provisions that designate the American Dental Association as the standard for dental carriers, not-for-profit carriers (such as Delta and Blue Cross) are not governed by such provisions.3. Many carriers created contracts based on previous CDT codes, and until these contracts expire, they will not change over to the new CDT codes, and4. Insurance carriers typically have large in-house computer systems that are complex, and it takes time to re-program them.The following is a summary of the American Dental Association CDT-2009/2010 Periodontaland related codes: Clinical Oral Evaluations CodesThe codes in this section recognize the cognitive skills necessary for patient evaluation.The collection and recording of some data and components of the dental examination maybedelegated; however, the evaluation, diagnosis and treatment planning are the responsibility of thedentist. As with all ADA procedure codes, there is no distinction made between the evaluationsprovided by general practitioners and specialists. Report additional diagnostic and/or definitiveprocedures separately.D0120 periodic oral evaluation – established patientAn evaluation performed on a patient of record to determine any changes inthe patient’s dentaland medical health status since a previous comprehensiveor periodic evaluation. This includes anoral cancer evaluation and periodontal screening where indicated, and may require interpretationof information acquired through additional diagnostic procedures. Report additional diagnosticprocedures separately. 14 of 24 2
  • 15. D0140 limited oral evaluation – problem focusedAn evaluation limited to a specific oral health problem or complaint. This may requireinterpretation of information acquired through additional diagnostic procedures. Reportadditional diagnostic procedures separately. Definitive procedures may be required on the samedate as the evaluation. Typically, patients receiving this type of evaluation present with a specificproblem and/or dental emergencies, trauma, acute infections, etc.D0150 comprehensive oral evaluation – new or established patientUsed by a general dentist and/or a specialist when evaluating a patient comprehensively.This applies to new patients; established patients who have had a significant change in healthconditions or other unusual circumstances, by report, or established patients who have beenabsent from active treatment for three or more years. It is a thorough evaluation and recording ofthe extraoral and intraoral hard and soft tissues. It may require interpretation of informationacquired through additional diagnostic procedures. Additional diagnostic procedures should bereported separately. This includes an evaluation for oral cancer where indicated, the evaluationand recording of the patient’s dental and medical history and a general health assessment. It mayinclude the evaluation and recording of dental caries, missing or unerupted teeth, restorations,existing prostheses, occlusal relationships, periodontal conditions (including periodontalscreening and/or charting), hard and soft tissue anomalies, etc.D0160 detailed and extensive oral evaluation – problem focused, by reportA detailed and extensive problem focused evaluation entails extensive diagnostic and cognitivemodalities based on the findings of a comprehensive oral evaluation. Integration of moreextensive diagnostic modalities to develop a treatment plan for a specific problem is required.The condition requiring this type of evaluation should be described and documented.Examples of conditions requiring this type of evaluation may include dentofacial anomalies,complicated perio-prosthetic conditions, complex temporomandibular dysfunction, facial painof unknown origin, conditions requiring multi-disciplinary consultation, etc.D0170 re-evaluation – limited, problem focused (established patient; notpost-operative visit) Assessing the status of a previously existing condition. For example:- traumatic injury where no treatment was rendered but patient needs follow-up monitoring;- evaluation for undiagnosed continuing pain;- soft tissue lesion requiring follow-up evaluation.D0180 comprehensive periodontal evaluation – new or established patientThis procedure is indicated for patients showing signs or symptoms of periodontaldisease and for patients with risk factors such as smoking or diabetes. It includes evaluation ofperiodontal conditions, probing and charting, evaluation and recording of the patient’s dental andmedical history and general health assessment. It may include the evaluation and recording of dentalcaries, missing or unerupted teeth, restorations, occlusal relationships and oral cancer evaluation. 15 of 24 3
  • 16. Preventive CodesD1110 prophylaxis – adultRemoval of plaque, calculus and stains from the tooth structures in the permanent andtransitional dentition. It is intended to control local irritational factors.Topical Fluoride Treatment (Office Procedure)Prescription strength fluoride product designed solely for use in the dental office, delivered to thedentition under the direct supervision of a dental professional. Fluoride must be appliedseparately from prophylaxis paste.D1204 topical application of fluoride (prophylaxis not included) – adultD1206 topical fluoride varnish; therapeutic application for moderate to highcaries risk patientsApplication of topical fluoride varnish, delivered in a single visit and involving the entire oralcavity. Not to be used for desensitization.D1310 nutritional counseling for control of dental diseaseCounseling on food selection and dietary habits as a part of treatment and control of periodontaldisease and caries.D1320 tobacco counseling for the control and prevention of oral diseaseTobacco prevention and cessation services reduce patient risks of developing tobacco-relatedoral diseases and conditions and improves prognosis for certain dental therapies.D1330 oral hygiene instructionsThis may include instructions for home care. Examples include tooth brushing technique,flossing, and use of special oral hygiene aids. Non-Surgical Periodontal CodesD4320 provisional splinting – intracoronalThis is an interim stabilization of mobile teeth. A variety of methods and appliances may beemployed for this purpose. Identify the teeth involved and the nature of the splint. 16 of 24 4
  • 17. D4321 provisional splinting – extracoronalThis is an interim stabilization of mobile teeth. A variety of methods and appliances may beemployed for this purpose. Identify the teeth involved and the nature of the splint.D4341 periodontal scaling and root planing – four or more teeth per quadrantThis procedure involves instrumentation of the crown and root surfaces of the teeth to removeplaque and calculus from these surfaces. It is indicated for patients with periodontal disease andis therapeutic, not prophylactic, in nature. Root planing is the definitive procedure designed forthe removal of cementum and dentin that is rough, and/or permeated by calculus or contaminatedwith toxins or microorganisms. Some soft tissue removal occurs. This procedure may be used asa definitive treatment in some stages of periodontal disease and/or as a part of pre-surgicalprocedures in others.D4342 periodontal scaling and root planing – one to three teeth per quadrantThis procedure involves instrumentation of the crown and root surfaces of the teeth to removeplaque and calculus from these surfaces. It is indicated for patients with periodontal disease andis therapeutic, not prophylactic, in nature. Root planing is the definitive procedure designed forthe removal of cementum and dentin that is rough, and/or permeated by calculus or contaminatedwith toxins or microorganisms. Some soft tissue removal occurs. This procedure may be used asa definitive treatment in some stages of periodontal disease and/or as a part of pre-surgicalprocedures in others.D4355 full mouth debridement to enable comprehensive evaluation and diagnosisThe gross removal of plaque and calculus that interfere with the ability of thedentist to perform a comprehensive oral evaluation. This preliminary proceduredoes not preclude the need for additional procedures.D4381 localized delivery of antimicrobial agents via a controlled releasevehicle into diseased crevicular tissue, per tooth, by reportFDA approved subgingival delivery devices containing antimicrobial medication(s) are insertedinto periodontal pockets to suppress the pathogenic microbiota. These devices slowly release thepharmacological agents so they can remain at the intended site of action in a therapeuticconcentration for a sufficient length of time.D4910 periodontal maintenanceThis procedure is instituted following periodontal therapy and continues at varying intervals,determined by the clinical evaluation of the dentist, for the life of the dentition or any implantreplacements. It includes removal of the bacterial plaque and calculus from supragingival andsubgingival regions, site specific scaling and root planing where indicated, and polishing theteeth. If new or recurring periodontal disease appears, additional diagnostic and treatmentprocedures must be considered.For implant maintenance procedures, please refer to Code D6080, Page 11 of this document.D4920 unscheduled dressing change (by someone other than treating dentist) 17 of 24 5
  • 18. Periodontal Surgical CodesLocal anesthesia is usually considered to be part of periodontal procedures. Also surgicalservices include usual postoperative care.Site: A term used to describe a single area, position, or locus. The word “site” is frequentlyused to indicate an area of soft tissue recession on a single tooth or an osseous defect adjacent toa single tooth; also used to indicate soft tissue defects and/or osseous defects in edentulous toothpositions.- If two contiguous teeth have areas of soft tissue recession, each area of recession is a single site.- If two contiguous teeth have adjacent but separate osseous defects, each defect is a single site.- If two contiguous teeth have a communicating interproximal osseous defect, it should be considered a single site.- All non-communicating osseous defects are single sites.- All edentulous non-contiguous tooth positions are single sites.- Depending on the dimensions of the defect, up to two contiguous edentulous tooth positions may be considered a single site.D4210 gingivectomy or gingivoplasty – four or more contiguous teeth or toothbounded spaces per quadrantInvolves the excision of the soft tissue wall of the periodontal pocket by either an external or aninternal bevel. It is performed to eliminate suprabony pockets after adequate initial preparation,to allow access for restorative dentistry in the presence of suprabony pockets, or to restorenormal architecture when gingival enlargements or asymmetrical or unaesthetic topography isevident with normal bony configuration.D4211 gingivectomy or gingivoplasty – one to three contiguous teeth or toothbounded spaces per quadrantInvolves the excision of the soft tissue wall of the periodontal pocket by either an external or aninternal bevel. It is performed to eliminate suprabony pockets after adequate initial preparation,to allow access for restorative dentistry in the presence of suprabony pockets, or to restorenormal architecture when gingival enlargements or asymmetrical or unaesthetic topography isevident with normal bony configuration.D4230 anatomical crown exposure – four or more contiguous teeth per quadrantThis procedure is utilized in an otherwise periodontally healthy area to remove enlarged gingivaltissue and supporting bone (ostectomy) to provide an anatomically correct gingival relationship. 18 of 24 6
  • 19. D4231 anatomical crown exposure – one to three teeth per quadrantThis procedure is utilized in an otherwise periodontally healthy area to remove enlarged gingivaltissue and supporting bone (ostectomy) to provide an anatomically correct gingival relationship.D4240 gingival flap procedure, including root planing – four or morecontiguous teeth or tooth bounded spaces per quadrantA soft tissue flap is reflected or resected to allow debridement of the root surface and theremoval of granulation tissue. Osseous recontouring is not accomplished in conjunction with thisprocedure. May include open flap curettage, reverse bevel flap surgery, modified Kirkland flapprocedure, and modified Widman surgery. This procedure is performed in the presence ofmoderate to deep probing depths, loss of attachment, need to maintain esthetics, need forincreased access to the root surface and alveolar bone, or to determine the presence of a crackedtooth, fractured root, or external root resorption. Other procedures may be required concurrent toD4240 and should be reported separately using their own unique codes.D4241 gingival flap procedure, including root planing – one to threecontiguous teeth or tooth bounded spaces per quadrantA soft tissue flap is reflected or resected to allow debridement of the root surface and theremoval of granulation tissue. Osseous recontouring is not accomplished in conjunction with thisprocedure. May include open flap curettage, reverse bevel flap surgery, modified Kirkland flapprocedure, and modified Widman surgery. This procedure is performed in the presence ofmoderate to deep probing depths, loss of attachment, need to maintain esthetics, need forincreased access to the root surface and alveolar bone, or to determine the presence of a crackedtooth, fractured root, or external root resorption. Other procedures may be required concurrent toD4241 and should be reported separately using their own unique codes.D4245 apically positioned flapProcedure is used to preserve keratinized gingiva in conjunction with osseous resection andsecond stage implant procedure. Procedure may also be used to preserve keratinized/attachedgingiva during surgical exposure of labially impacted teeth, and may be used during treatment ofperi-implantitis.D4249 clinical crown lengthening – hard tissueThis procedure is employed to allow restorative procedure or crown with little or no toothstructure exposed to the oral cavity. Crown lengthening requires reflection of a flap and isperformed in a healthy periodontal environment, as opposed to osseous surgery, which isperformed in the presence of periodontaldisease. Where there are adjacent teeth, the flap designmay involve a larger surgical area.D4260 osseous surgery (including flap entry and closure) – four or morecontiguous teeth or tooth bounded spaces per quadrantThis procedure modifies the bony support of the teeth by reshaping the alveolar process toachieve a more physiologic form. This may include the removal of supporting bone (ostectomy)and/or non-supporting bone (osteoplasty). Other procedures may be required concurrent to CodeD4260 and should be reported using their own unique codes. 19 of 24 7
  • 20. D4261 osseous surgery (including flap entry and closure) – one to threecontiguous teeth or tooth bounded spaces per quadrantThis procedure modifies the bony support of the teeth by reshaping the alveolar process toachieve a more physiologic form. This may include the removal of supporting bone (ostectomy)and/or non-supporting bone (osteoplasty). Other procedures may be required concurrent to CodeD4261 and should be reported using their own unique codes.D4263 bone replacement graft – first site in quadrantThis procedure involves the use of osseous autografts, osseous allografts, or non-osseous graftsto stimulate periodontal regeneration when the disease process has led to a deformity of the bone.This procedure does not include flap entry and closure, wound debridement, osseous contouring,or the placement of biologic materials to aid in osseous tissue regeneration or barriermembranes. Other separate procedures may be required concurrent to Code D4263 and shouldbe reported using their own unique codes. Definition for the term “site” precedes Code D4210.D4264 bone replacement graft – each additional site in quadrantThis procedure involves the use of osseous autografts, osseous allografts, or non-osseous graftsto stimulate periodontal regeneration when the disease process has led to a deformity of the bone.This procedure does not include flap entry and closure, wound debridement, osseous contouring,or the placement of biologic materials to aid in osseous tissue regeneration or barrier membranes.This code is used if performed concurrently with Code D4263 and allows reporting of the exactnumber of sites involved. Definition for the term “site” precedes Code D4210.D4265 biologic materials to aid in soft and osseous tissue regenerationBiologic materials may be used alone or with other regenerative substratessuch as bone andbarrier membranes, depending upon their formulation and the presentation of the periodontaldefect. This procedure does not include surgical entry and closure, wound debridement, osseouscontouring, or the placement of graft materials and/or barrier membranes. Other separateprocedures may be required concurrent to Code D4265 and should be reported using their ownunique codes.D4266 guided tissue regeneration – resorbable barrier, per siteA membrane is placed over the root surfaces or defect area following surgical exposure anddebridement. The mucoperiosteal flaps are then adapted over the membrane and sutured. Themembrane is placed to exclude epithelium and gingival connective tissue from the healingwound. This procedure may require subsequent surgical procedures to correct the gingivalcontours. Guided tissue regeneration may also be carried out in conjunction with bonereplacement grafts or to correct deformities resulting from inadequate faciolingual bone width inan edentulous area. When guided tissue regeneration is used in association with a tooth, each siteon a specific tooth should be reported separately. Other separate procedures may be requiredconcurrent to Code D4266 and should be reported using their own unique codes. Definition forthe term “site” precedes Code D4210. 20 of 24 8
  • 21. D4267 guided tissue regeneration – nonresorbable barrier, per site (includesmembrane removal)This procedure is used to regenerate lost or injured periodontal tissue by directing differentialtissue responses. A membrane is placed over the root surfaces or defect area following surgicalexposure and debridement. The mucoperiosteal flaps are then adapted over the membrane andsutured. This procedure does not include flap entry and closure, wound debridement,osseous contouring, bone replacement grafts, or the placement of biologicmaterials to aid inosseous tissue regeneration. The membrane is placed to exclude epithelium and gingivalconnective tissue from the healing wound. This procedure requires subsequent surgicalprocedures to remove the membranes and/or to correct the gingival contours. Guided tissueregeneration may be used in conjunction with bone replacement grafts or to correct deformitiesresulting from inadequate faciolingual bone width in an edentulous area. When guided tissueregeneration is used in association with a tooth, each site on a specific tooth should be reportedseparately with this code. When no tooth is present, each site should be reported separately.Other separate procedures may be required concurrent to D4267 and should be reported usingtheir own unique codes. Definition for the term “site” precedes Code D4210.D4268 surgical revision procedure, per toothThis procedure is to refine the results of a previously provided surgical procedure. This mayrequire a surgical procedure to modify the irregular contours of hard or soft tissue. Amucoperiosteal flap may be elevated to allow access to reshape alveolar bone. The flaps arereplaced or repositioned and sutured.D4270 pedicle soft tissue graft procedureA pedicle flap of gingiva can be raised from an edentulous ridge, adjacent teeth, or from theexisting gingiva on the tooth and moved laterally or coronally to replace alveolar mucosa asmarginal tissue. The procedure can be used to cover an exposed root or to eliminate a gingivaldefect if the root is not too prominent in the arch.D4271 free soft tissue graft procedure (including donor site surgery)Gingival or masticatory mucosa is grafted to create or augment the gingiva at another site, withor without root coverage. This graft may also be used to eliminate the pull of frena and muscleattachments, to extend the vestibular fornix, and to correct localized gingival recession.D4273 subepithelial connective tissue graft procedures, per toothThis procedure is performed to create or augment gingiva, to obtain root coverage to eliminatesensitivity and to prevent root caries, to eliminate frenum pull, to extend the vestibular fornix, toaugment collapsed ridges, to provide an adequate gingival interface with a restoration or to coverbone or ridge regeneration sites when adequate gingival tissues are not available for effectiveclosure. There are two surgical sites. The recipient site utilizes a split thickness incision,retaining the overlying flap of gingiva and/or mucosa. The connective tissue is dissectedfrom the donor site leaving an epithelialized flap for closure. After the graft is placed on therecipient site, it is covered with the retained overlying flap. 21 of 24 9
  • 22. D4274 distal or proximal wedge procedure (when not performed inconjunction with surgical procedures in the same anatomical area)This procedure is performed in an edentulous area adjacent to a periodontally involved tooth.Gingival incisions are utilized to allow removal of a tissue wedge to gain access and correct theunderlying osseous defect and to permit close flap adaptation.D4275 soft tissue allograftProcedure is performed to create or augment the gingiva, with or without root coverage. Thismay be used to eliminate the pull of the frena and muscle attachments, to extend the vestibularfornix, and correct localized gingival recession. There is no donor site.D4276 combined connective tissue and double pedicle graft, per toothAdvanced gingival recession often cannot be corrected with a single procedure. Combined tissuegrafting procedures are needed to achieve the desired outcome ImplantsReport surgical implant procedure using codes in this section; prosthetic devices should bereported using existing fixed or removable prosthetic codes. Local anesthesia is usuallyconsidered to be part of Implant Services procedures.Pre-Surgical ServicesD6190 radiographic/surgical implant index, by reportAn appliance, designed to relate osteotomy or fixture position anatomic structures, to be utilizedduring radiographic exposure planning and/or during osteotomy creation for fixture installation.Surgical ServicesReport surgical implant procedure using codes in this section.D6010 surgical placement of implant body: endosteal implantIncludes second stage surgery and placement of healing cap.D6012 surgical placement of interim implant body for transitional endosteal implantIncludes removal during later therapy to accommodate the definitive, which may includeplacement of other implants.D6040 surgical placement: eposteal implantAn eposteal (subperiosteal) framework of a biocompatible material and fabricated to fit on thesurface of the bone of the mandible or permucosal extensions that provide support andattachment of a This may be a complete arch or unilateral appliance. Eposteal implants upon thebone and under the periosteum. 22 of 24 10
  • 23. D6050 surgical placement: transosteal implantA transosteal (transosseous) biocompatible device with threaded posts both the superior andinferior cortical bone plates of the mandibular and exiting through the permucosa providingsupport and attachment dental prosthesis. Transosteal implants are placed completelybone and into the oral cavity from extraoral or intraoral.D6100 implant removal, by reportThis procedure involves the surgical removal of an implant. Describe procedure.D6080 implant maintenance procedures, including removal of prosthesis,cleansing of prosthesis and abutments and reinsertion of prosthesisThis procedure includes a prophylaxis to provide active debriding of the implant andexamination of all aspects of the implant system, including the occlusion and stabilityof the superstructure. The patient is also instructe in thorough daily cleansing of the implant. Other Service CodesD9910 application of desensitizing medicamentIncludes in-office treatment for root sensitivity. Typically reported on a “per visit” basis forapplication of topical fluoride. This code is not to be used for bases, liners or adhesives usedunder restorations.D9911 application of desensitizing resin for cervical and/or root surface,per toothTypically reported on a “per tooth” basis for application of adhesive resins. This code is not to beused for bases, liners, or adhesives used under restorations.D9920 behavior management, by reportMay be reported in addition to treatment provided. Should be reported in 15-minute increments.D9930 treatment of complications (post-surgical) – unusual circumstances, by reportFor example, treatment of a dry socket following extraction or removal of bony sequestrum.D9940 occlusal guard, by reportRemovable dental appliances, which are designed to minimize the effects of bruxism (grinding)and other occlusal factors.D9941 fabrication of athletic mouthguardD9942 repair and/or reline of occlusal guard 23 of 24 11
  • 24. D9950 occlusion analysis – mounted caseIncludes, but is not limited to, facebow, interocclusal records tracings, and diagnostic wax-up;for diagnostic casts, see Code D0470.D9951 occlusal adjustment – limitedMay also be known as equilibration; reshaping the occlusal surfaces of teeth to createharmonious contact relationships between the maxillary and mandibular teeth. Presently includesdiscing/odontoplasty/enamoplasty. Typically reported on a “per visit” basis. This should not bereported when the procedure only involves bite adjustment in the routine post-delivery care for adirect/indirect restoration or fixed/removable prosthodontics.D9952 occlusal adjustment – completeOcclusal adjustment may require several appointments of varying length, and sedation may benecessary to attain adequate relaxation of the musculature. Study casts mounted on anarticulating instrument may be utilized for analysis of occlusal disharmony. It is designed toachieve functional relationships and masticatory efficiency in conjunction with restorativetreatment, orthodontics, orthognathic surgery, or jaw trauma when indicated. Occlusaladjustment enhances the healing potential of tissues affected by the lesions of occlusal trauma.D9971 odontoplasty 1-2 teeth; includes removal of enamel projections Unspecified Periodontal Procedures D9999 Unspecified Periodontal Procedure, by report Use for a procedure, which is not adequately described by a code. Describe procedure. Let the insurance company know exactly what you have done or propose to do. Your report can help establish rapport with the insurance company consultants who will be receiving the claim. It’s easier for the consultant to approve a claim when thorough information is provided. 24 of 24 12

×