When is D4273 used?
The D4273 dental code applies to autogenous connective tissue graft procedures, covering both the donor and recipient surgical areas for the initial tooth, implant, or edentulous position within the graft. This CDT code is utilized when a dental professional harvests connective tissue—usually from the patient's palatal area—and transfers it to a different location in the mouth to address gingival recession, enhance attached gingiva, or prepare an area for upcoming restorative procedures. D4273 must be reported exclusively for the initial site treated within one surgical appointment; subsequent sites may need a separate code, like D4277 for each extra location.
D4273 Charting and Clinical Use
Proper documentation remains crucial for effective claim processing and payment. Clinical records must clearly outline:
The diagnosis and clinical justification for the graft (such as root exposure, insufficient keratinized tissue).
The exact donor and recipient locations, including specific tooth numbers or edentulous regions.
The surgical approach utilized and the volume of tissue collected.
Before and after photographs or radiographs, when available, to demonstrate the procedure's necessity.
Typical clinical applications for D4273 involve addressing severe gingival recession around one tooth, preparing an implant location with limited soft tissue, or enhancing tissue in an edentulous region before prosthetic installation.
Billing and Insurance Considerations
Processing claims for D4273 demands careful attention and proactive insurer communication. Consider these recommended practices:
Benefits Verification: Prior to treatment, confirm the patient's coverage for periodontal surgery and grafting procedures. Coverage for soft tissue grafts varies among plans, and some may need pre-authorization.
Claim Processing: File a comprehensive claim including the D4273 code, supporting clinical records, and any necessary radiographs or photographs. Specify the tooth number or edentulous location clearly.
Payment Review: Thoroughly examine Explanation of Benefits statements for payment correctness. When claims are rejected, verify for incomplete documentation or coverage restrictions.
Appeal Procedures: When required, file a claim appeal including extra clinical justification, such as before-and-after photographs and a written explanation of the graft's medical necessity.
When treating multiple graft locations, make sure to apply appropriate codes for each extra site, like D4277 for additional connective tissue grafts.
How dental practices use D4273
Take a patient with substantial gingival recession on tooth #24, causing root sensitivity and potential for additional tissue deterioration. Following insurance verification that confirms D4273 coverage, the periodontist records the clinical observations, takes pre-operative photographs, and discusses the procedure with the patient. Throughout the surgery, connective tissue gets harvested from the palatal area and transplanted to the treatment site. The procedure receives complete documentation, noting tooth number, surgical method, and post-operative care instructions. The claim gets filed with D4273, clinical documentation, and photographs, leading to successful payment following payment review.
Through these procedures and comprehensive record-keeping, dental practices can optimize reimbursement and maintain compliance when processing D4273 connective tissue graft procedures.
Common Questions
Why might an insurance claim for D4273 be rejected?
Insurance claims for D4273 are frequently denied due to inadequate documentation, including missing clinical notes, photographs, or periodontal charting records. Other common rejection reasons include failure to demonstrate medical necessity, exceeding frequency limits for grafting procedures, or incorrectly applying the code to non-autogenous graft materials. Claims may also be rejected when the procedure falls outside the patient's coverage plan or when policy terms specifically exclude grafts for particular clinical situations.
Is it possible to bill D4273 with other periodontal treatments in the same appointment?
D4273 may be billed together with other periodontal procedures during the same visit, provided they are performed at separate sites and are clinically justified. It's essential to review individual payer policies, as certain insurance companies may combine procedures or limit coverage for multiple surgical interventions in one session. Comprehensive documentation for each individual procedure is crucial for successful billing.
What's the best approach for obtaining pre-authorization for D4273?
Dental practices should reach out to the patient's insurance carrier prior to treatment to verify whether pre-authorization is necessary for D4273. This process typically requires submitting clinical records, photographs, and a comprehensive narrative justifying the medical necessity of the graft procedure. Securing pre-authorization helps minimize claim rejection risks and ensures patients understand their out-of-pocket costs before treatment begins.