This month I’ll review coding for osseous surgery–four or more contiguous teeth or tooth bounded spaces per quadrant.
Here’s what you need to keep in mind with this code.
• This code is used to report four or more teeth per quadrant. If there are fewer teeth per quad report D4261
• Scaling and root planing and/or periodontal maintenance should be reported prior to requesting benefits for osseous surgery, with a minimum of six weeks to allow for reevaluation prior to performing the osseous surgery.
• Periodontal charting should indicate pocket depths of 5 mm or greater and be dated within six months in order to facilitate approval for osseous surgery benefits.
• Most union plans will limit reimbursement to only two quads per visit, and in some cases only one quad per visit. Be sure to find out before performing the treatment.
• If more than one periodontal surgery is performed on the same date of service and quadrant, such as osseous surgery and distal wedge, the insurance plan may only provide reimbursement for the osseous surgery and consider the distal wedge inclusive.
• Most plans limit frequency for osseous surgery to once every 36 months. Be sure to check with your patient's insurance company for history information.
Be sure to send your ADA claim form with periodontal charting, full mouth x-rays, and a short narrative explaining the reason for necessity.
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