When is D4274 used?
The D4274 dental code represents a "mesial/distal wedge procedure, single tooth (when not performed in conjunction with surgical procedures in the same anatomical area)." This CDT code applies when a dental professional removes soft tissue from either the mesial or distal side of an individual tooth, usually to provide access for restorative work or periodontal treatment. It's important to understand that D4274 should not be billed if the wedge procedure occurs alongside other surgical treatments—like bone surgery or tooth extractions—in the same area during one visit. When combined with other procedures, the wedge technique becomes part of the main surgical service and cannot be billed separately.
D4274 Charting and Clinical Use
Proper documentation plays a vital role in securing reimbursement for D4274. Clinical records must clearly include:
The exact tooth number and location (mesial or distal) where the wedge procedure took place
The reason for performing the procedure (such as accessing decay, enabling crown preparation, or treating isolated gum problems)
Confirmation that no additional surgical work occurred in the same area during that appointment
Before and after findings, including pocket measurements, tissue health, and expected recovery
Typical clinical situations for D4274 involve cases where extra soft tissue blocks access for dental work, or when specific gum issues need targeted tissue removal without requiring extensive surgical treatment.
Billing and Insurance Considerations
To improve claim approval rates for D4274, consider these recommendations:
Check patient coverage before treatment to confirm periodontal procedure benefits and any usage limits.
Include comprehensive clinical records with claims, such as mouth photos, gum measurements, and written explanations of why the wedge procedure was necessary.
Apply the appropriate CDT code and avoid billing it with other surgical codes for the same area, which typically leads to claim rejection.
When claims get denied, examine the explanation of benefits for denial reasons, collect additional supporting materials, and file an appeal with clear justification for why D4274 stands as an independent procedure.
Being thorough with insurance checks and complete documentation can greatly reduce outstanding accounts and accelerate payment for this procedure code.
How dental practices use D4274
Take a patient who has extra soft tissue on the back side of tooth #19, making it impossible to place a crown margin correctly. The dentist removes this tissue using a mesial/distal wedge technique to create proper access. No other surgical work happens in that location during the appointment. The treatment notes specify the location, purpose, and aftercare instructions. The practice submits the claim using D4274, including mouth photos and written explanation. The insurance company reviews the materials and approves payment, leading to prompt reimbursement and patient satisfaction.
For situations involving additional periodontal surgical work, check codes like bone surgery (D4260) or gum removal (D4210) for accurate billing information.
Common Questions
Is it possible to bill D4274 alongside other periodontal treatments on different teeth within the same visit?
D4274 can indeed be billed during the same appointment when other periodontal procedures are performed, provided these treatments occur on different teeth or separate anatomical regions. The critical guideline is that D4274 must not be reported for any tooth when additional surgical procedures are conducted in the identical anatomical area on the same service date. Proper documentation should clearly differentiate between treatment sites and the specific procedures completed at each location.
What steps should a dental office take when an insurance company denies a D4274 claim even with adequate documentation?
When facing an insurance denial for D4274 despite complete documentation, the practice should first examine the specific denial reasoning and then craft a comprehensive appeal letter. This appeal must contain detailed clinical notes, supporting radiographs, intraoral photographs, and a thorough explanation demonstrating medical necessity. Include references to the official CDT code definition and emphasize that no additional surgical interventions occurred in the same anatomical region. Consistent follow-up combined with thorough documentation typically results in successful claim reversals.
What are the most frequent coding mistakes to prevent when filing D4274 claims?
Frequent coding mistakes involve improper unbundling of related procedures, upcoding to more complex treatment codes than actually performed, or incorrectly applying D4274 when additional surgical procedures occurred in the same anatomical area. To prevent claim rejections, use D4274 exclusively when it represents the only surgical intervention in the specific anatomical region and verify that all supporting documentation justifies its application.