When is D4267 used?
The D4267 dental code represents "Guided Tissue Regeneration – Nonresorbable Barrier, Per Site." This CDT code applies when dental professionals perform guided tissue regeneration (GTR) procedures utilizing nonresorbable barrier membranes to promote bone and tissue regrowth following periodontal disease damage. D4267 is suitable for regenerating tooth-supporting structures, particularly in advanced periodontal defect cases. This code excludes procedures using resorbable barriers (refer to D4266 for resorbable options), or standard bone grafting procedures without membrane application.
D4267 Charting and Clinical Use
Proper documentation is crucial for reimbursement success. When submitting D4267 claims, clinical records must clearly document:
The particular periodontal defect addressed (such as intrabony defects or furcation involvement)
Nonresorbable barrier membrane usage, including membrane type and placement location
Before and after radiographic images or clinical photos
Comprehensive narrative justifying GTR medical necessity
Typical clinical applications for D4267 involve treating severe periodontal pockets with vertical bone loss, or molar furcation defects requiring regeneration for tooth stability. Include periodontal measurements and radiographic proof to strengthen claims.
Billing and Insurance Considerations
Successfully billing D4267 demands careful attention to insurance policies and documentation requirements. Follow these practical steps to improve claim approval rates:
Confirm benefits: Prior to treatment, check patient insurance coverage for GTR procedures, as certain plans may exclude regenerative treatments or impose frequency restrictions.
Provide thorough documentation: Include clinical records, radiographs, and detailed narratives with claims. Emphasize bone loss severity and nonresorbable membrane necessity.
Apply proper coding: Avoid mixing D4267 with related codes like D4266 (resorbable barrier) or D4265 (biological materials). Precise coding prevents rejections and processing delays.
Challenge denials: When receiving denial EOBs, examine reason codes, compile additional supporting evidence, and file prompt appeals with clear medical necessity explanations.
How dental practices use D4267
A patient arrives with a Class II furcation defect affecting a lower molar, verified through probing and X-rays. Following scaling and root planing, the periodontist decides guided tissue regeneration using a nonresorbable membrane is necessary to rebuild lost bone and preserve the tooth. The treatment team records the defect, captures before and after images, and creates a comprehensive narrative. They submit the claim using D4267 with complete supporting materials. Insurance initially rejects the claim for insufficient justification, but the practice appeals with extra radiographs and enhanced documentation, ultimately achieving successful payment.
This case demonstrates the critical role of complete documentation, accurate coding, and determination in the D4267 claims process.
Common Questions
Is it possible to bill D4267 together with other periodontal treatments?
D4267 can indeed be billed with other periodontal treatments when medically necessary. For instance, when guided tissue regeneration is combined with bone grafting procedures, you should report both D4267 for the membrane placement and the corresponding bone graft code. It's essential to document each procedure individually and ensure your billing accurately represents all services rendered.
How frequently can D4267 be billed for the same patient?
Dental insurance plans typically impose frequency restrictions on periodontal treatments, including D4267. Generally, guided tissue regeneration coverage is limited to once per treatment site within a specified period, usually ranging from 3 to 5 years. It's important to review the patient's specific insurance policy for exact frequency limitations prior to treatment planning.
What causes D4267 claim denials and how can they be prevented?
Claim denials frequently occur due to inadequate documentation, insufficient clinical rationale, or the treatment not being covered under the patient's benefits. To minimize denials, ensure you provide thorough clinical documentation including detailed notes, radiographic images, periodontal measurements, and a comprehensive treatment rationale explaining the necessity for guided tissue regeneration. Additionally, verifying insurance benefits and securing prior authorization when necessary can significantly reduce claim rejection rates.