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Navigating Dental Codes with Kyle: D4260–Osseous Surgery Insights

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Navigating Dental Codes with Kyle: D4260 Osseous Surgery Insights

Understanding dental codes is crucial for accurate billing and insurance claims, particularly for specific procedures like osseous surgery. This article will delve into the intricacies of the D4260 osseous surgery code, which applies to cases involving four or more contiguous teeth or tooth-bounded spaces within a quadrant.

Key Points for Using Code D4260 osseous surgery

  1. Appropriate Use of D4260:

  • Applicability: The D4260 osseous surgery code is used for cases involving four or more contiguous teeth or tooth-bounded spaces within a quadrant.

  • Alternative Code: For cases involving fewer teeth (1-3 per quadrant), use code D4261 instead.

2. Pre-Surgery Requirements:

  • Prior Procedures: Before considering D4260 osseous surgery, ensure that scaling, root planing, and/or periodontal maintenance have been completed.

  • Reevaluation Period: Allow at least six weeks for reevaluation post-scaling and root planing before undergoing osseous surgery.

3. Documentation for Approval:

  • Periodontal Charting: Detailed periodontal charting is essential. Document 5 mm or greater pocket depths, dated within the last six months, to facilitate approval for D4260 osseous surgery benefits.

  • Insurance Requirements: Understand and confirm specific insurance requirements and restrictions related to D4260 osseous surgery.

4. Insurance Reimbursement Guidelines:

  • Quadrant Limits: Many union plans limit reimbursement to a maximum of two quadrants per visit, sometimes only one. Clarify these restrictions before initiating treatment involving D4260 osseous surgery.

  • Multiple Surgeries: If multiple periodontal surgeries are performed on the same date and quadrant, such as D4260 osseous surgery and a distal wedge, insurance may only reimburse for the osseous surgery, considering the distal wedge as part of the comprehensive treatment.

5. Frequency Restrictions:

  • Surgery Frequency: Dental plans typically restrict the frequency of D4260 osseous surgery to once every 36 months. Verify the patient’s insurance history for precise information.

6. Claim Submission Essentials:

  • ADA Claim Form: Ensure submission of the 2024 ADA claim form.

  • Supporting Documentation: Include periodontal charting, full-mouth x-rays, and a concise narrative explaining the necessity of the D4260 osseous surgery treatment.

Navigating dental codes like D4260 osseous surgery can be complex, but a thorough understanding and proper documentation can streamline the process. By following these guidelines, dental offices can ensure accurate billing and maximize the chances of insurance approval for osseous surgery procedures.

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