When is D4210 used?
The D4210 dental code applies to gingivectomy or gingivoplasty treatments involving four or more adjacent teeth or bounded tooth spaces within a single quadrant. This CDT code is appropriate when gum tissue removal and reshaping becomes necessary for conditions like gingival overgrowth, significant periodontal pockets, or to support restorative treatment planning. Simple gum trimming or treatments affecting fewer than four teeth require different coding, such as D4211 for procedures involving three or fewer teeth.
D4210 Charting and Clinical Use
Proper documentation plays a crucial role in claim acceptance. Patient records must clearly show the diagnosis (such as chronic gingival hyperplasia), identify treated teeth or regions, and justify the medical need for surgical intervention. Documentation should include initial periodontal measurements, clinical photographs, and relevant X-rays where appropriate. When gingivectomy serves to enhance restorative access or address ongoing pocket depths following non-surgical periodontal therapy, these clinical reasons must be thoroughly documented. Always verify that your records support D4210 usage rather than codes for less extensive procedures.
Billing and Insurance Considerations
Before submitting D4210 claims, check patient benefit coverage for periodontal surgical treatments. Insurance providers often require proof of previous conservative treatment, including scaling and root planing, along with supporting materials like pocket depth measurements and diagnostic images. Include a comprehensive treatment narrative explaining the diagnosis, prior interventions, and surgical necessity. When claims face denial, carefully examine the Explanation of Benefits to understand rejection reasons and prepare detailed appeals with any additional clinical evidence the insurer requests. Consistent follow-up on outstanding claims helps ensure timely payment processing.
How dental practices use D4210
A 52-year-old patient shows widespread gum overgrowth in the upper right section, affecting teeth #2 through #5. Earlier non-surgical periodontal treatment did not improve the condition. The treating periodontist records ongoing 6-7mm pocket depths and patient difficulty with home care maintenance. Following pre-treatment photography and pocket depth recording, the doctor completes gingivectomy treatment on the four affected teeth. The practice submits the D4210 claim with complete clinical documentation, photographs, and a detailed explanation of unsuccessful conservative therapy and treatment necessity. The insurance company approves payment based on the thorough documentation and justified clinical approach.
Common Questions
Is it possible to bill D4210 alongside other periodontal treatments in the same quadrant?
D4210 cannot be billed together with other periodontal surgical procedures (including osseous surgery D4260 or crown lengthening D4249) for identical teeth within the same quadrant during a single appointment. This practice may lead to claim rejections or documentation requests. It's essential to review payer policies and ensure treatments are properly separated based on clinical requirements and proper documentation.
What is the allowable frequency for D4210 procedures per patient or quadrant?
D4210 frequency limits depend on individual insurance plan terms. Most insurance providers restrict coverage to once per quadrant every 24 to 36 months. It's crucial to confirm coverage details with the insurance company prior to treatment and maintain thorough documentation of clinical justification for any repeated procedures to validate claims.
What typically causes insurance companies to deny D4210 claims?
Insurance denials for D4210 commonly occur due to inadequate documentation (including absent periodontal charts or clinical photographs), insufficient proof of medical necessity, violations of frequency restrictions, or misidentification with related procedure codes. Submitting thorough documentation along with detailed clinical narratives helps minimize claim rejections.