When is D4285 used?
The D4285 dental code applies to non-autogenous connective tissue graft procedures that encompass both the recipient surgical area and donor material, billed for each extra contiguous tooth, implant, or edentulous tooth position within the same region. This code applies when patients need soft tissue grafting to treat conditions like root exposure, insufficient keratinized tissue, or prosthetic preparation, with multiple adjacent sites addressed in one surgical session. D4285 must be reported alongside the primary graft code (typically D4273 for the initial site), with D4285 accounting for each extra contiguous site treated in the same quadrant or region.
D4285 Charting and Clinical Use
Proper documentation remains crucial for successful D4285 reimbursement. Clinical records must clearly document:
Specific teeth, implants, or edentulous areas treated
Treatment rationale (such as recession, insufficient attached gingiva, or pre-prosthetic requirements)
Procedure specifics, including donor site location, graft material type, and surgical technique
Before and after photographs plus periodontal measurements
Typical clinical situations involve addressing multiple neighboring teeth with recession issues or preparing edentulous ridge sections for implant placement. For instance, when a patient has recession affecting teeth #24, #25, and #26, D4273 covers the initial tooth while D4285 accounts for each subsequent contiguous tooth.
Billing and Insurance Considerations
Optimizing D4285 reimbursement demands a strategic approach:
Prior Authorization: Always confirm benefits and secure prior authorization, since many insurers demand clinical justification and supporting evidence before approving soft tissue grafts.
Proper Coding: Combine D4285 with the primary graft code and verify each additional site is genuinely contiguous. Separate sites should be billed individually.
Comprehensive Documentation: Submit clinical records, periodontal measurements, and clear photographs with claims to minimize denials or information requests.
Challenge Denials: When claims are rejected, examine the explanation of benefits for reasons, add supplementary documentation, and file prompt appeals. Emphasize medical necessity and the number of contiguous sites addressed.
How dental practices use D4285
Scenario: A patient shows significant gingival recession on teeth #22 through #27. The periodontist completes connective tissue grafting on all six teeth within one quadrant. The billing includes:
D4273 for the initial site (tooth #22)
D4285 for each subsequent contiguous tooth (#23, #24, #25, #26, #27)
Clinical records contain pre-treatment images, periodontal data, and detailed notes explaining the functional and cosmetic necessity for grafting. The billing specialist submits the claim with complete supporting documentation, and the insurer approves payment for all six sites following thorough review of the detailed records.
Understanding the proper application of D4285 helps dental practices ensure correct billing, minimize claim rejections, and maximize reimbursement for multiple-site soft tissue graft treatments.
Common Questions
Can D4285 be applied to grafts involving non-adjacent teeth or implants?
No, D4285 is designated exclusively for additional adjacent teeth, implants, or edentulous sites treated within the same surgical area. For non-adjacent locations, a separate primary graft code (like D4273) must be used for each individual area.
How many times can D4285 be billed during a single surgical procedure?
The frequency of D4285 billing is determined by the number of additional adjacent sites treated beyond the initial graft location. Nevertheless, insurance providers may impose their own frequency limits or restrictions, so it's essential to confirm coverage with the carrier prior to treatment.
What are typical causes for insurance rejection of D4285 claims?
Typical rejection causes include inadequate documentation, absent clinical photographs or periodontal charting, missing detailed narrative descriptions, or incorrectly billing D4285 for non-adjacent sites. Providing thorough and precise submissions can help minimize rejections.