When is D4276 used?
The D4276 dental code applies to combined connective tissue and double pedicle grafting procedures performed on individual teeth. This CDT code is utilized when dental professionals execute soft tissue grafting that incorporates both connective tissue harvesting (typically from the patient's palatal area) and repositioning of surrounding gum tissue through pedicle flaps to address exposed root surfaces or enhance thin gingival tissue. D4276 differs from other grafting codes as it specifically covers the simultaneous application of both techniques on one tooth, which is generally recommended for severe recession cases or complex periodontal conditions where single-technique grafting would yield suboptimal outcomes.
D4276 Charting and Clinical Use
Proper documentation is essential for successful claim processing when submitting D4276. Clinical records must clearly include:
Identification of the treated tooth or teeth
Pre-treatment diagnosis and grafting rationale (such as Miller Class III recession, insufficient keratinized tissue)
Procedural specifics, including connective tissue source and double pedicle flap creation
Supporting evidence through pre- and post-treatment photographs, periodontal measurements, and radiographic images
Typical applications for D4276 involve treating teeth with substantial root exposure, particularly in cosmetic areas, or cases where previous single-technique grafts were unsuccessful. This code is not appropriate for basic free gingival grafts (D4277) or single pedicle treatments (D4278).
Billing and Insurance Considerations
To optimize reimbursement for D4276, dental billing professionals should implement these strategies:
Confirm patient coverage prior to treatment, since many insurance plans impose restrictions on periodontal grafting or mandate specific documentation requirements.
Provide comprehensive narratives with claims, explaining the clinical necessity for combining connective tissue and double pedicle methods.
Attach all relevant documentation (photographs, periodontal charts, radiographs) to initial submissions to minimize information requests or claim rejections.
When claims are rejected, file appeals quickly with enhanced clinical justification and CDT code definition references.
Monitor claims through your accounts receivable system and maintain regular follow-up to ensure prompt payment processing.
Keep in mind that insurance companies may bundle or reduce grafting procedure codes, making comprehensive documentation and proactive insurer communication crucial.
How dental practices use D4276
A patient arrives with significant recession affecting tooth #8, showing insufficient keratinized tissue and a history of failed single-technique grafting. The periodontist records the necessity for a combination approach, obtaining connective tissue from the palatal region and forming double pedicle flaps from neighboring teeth. Complete pre- and post-treatment images, comprehensive clinical documentation, and an explanatory narrative detailing the procedure's complexity accompany the claim submission. While the insurance company initially seeks additional information, the practice quickly provides supplementary documentation, resulting in claim acceptance and complete D4276 reimbursement.
This scenario demonstrates how comprehensive documentation, effective communication, and persistent follow-up contribute to successful billing for advanced periodontal treatments using the D4276 dental code.
Common Questions
Is it possible to bill D4276 alongside other graft codes for the same tooth?
D4276 cannot be billed with additional grafting codes when treating the same tooth. This code encompasses both the connective tissue graft and double pedicle graft procedures performed simultaneously on one tooth. Attempting to unbundle these procedures or adding supplementary grafting codes for the identical treatment site may lead to claim rejections or trigger insurance reviews.
What patient circumstances would make D4276 an unsuitable code choice?
D4276 is unsuitable when only a single graft type (connective tissue or double pedicle) is performed, or when treatments occur on different teeth. This code is also inappropriate for mild recession situations where less complex grafting methods would be adequate. Use D4276 exclusively when both graft procedures are clinically necessary and executed simultaneously on the same tooth.
What is the proper approach for obtaining pre-authorization for D4276 treatments?
Practices should reach out to the patient's insurance carrier before beginning treatment to verify pre-authorization requirements for D4276. This process includes submitting comprehensive treatment plans, clinical documentation, and supporting materials like photographs or X-rays. Obtaining pre-authorization minimizes claim rejection risks and ensures patients understand their coverage benefits and financial responsibilities.