When is D6102 used?
The D6102 dental code applies to debridement and bone contouring procedures for peri-implant defects around a single dental implant. This treatment includes cleaning exposed implant surfaces and involves flap access with closure. Dental professionals should apply D6102 for treating peri-implantitis or similar peri-implant conditions requiring surgical treatment beyond standard maintenance or basic cleaning. This code is not suitable for regular implant care (refer to D6080) or treatments involving multiple implants in one location.
D6102 Charting and Clinical Use
Proper documentation is essential for D6102 billing. Clinical records must clearly outline the peri-implant defect presence and severity, surgical debridement necessity, and procedural steps performed. Include pre-treatment radiographs, periodontal measurements, and surgical photos where available. Typical clinical situations include:
Patients with peri-implantitis and bone deterioration around one implant
Situations where non-surgical treatment has been unsuccessful and surgery is required
Visible implant threads with related inflammation and bone deterioration
Ensure documentation covers patient symptoms, clinical observations, and reasoning for selecting surgical debridement with bone contouring.
Billing and Insurance Considerations
When processing claims for D6102, implement these strategies to enhance claim approval and reduce rejections:
Prior approval: Verify patient insurance coverage and pre-approval needs, as many insurers classify this as medically necessary treatment.
Comprehensive narratives: Include clear, brief explanations covering diagnosis (such as peri-implantitis), prior treatment attempts, and clinical reasons for surgical approach.
Evidence documentation: Provide radiographs, periodontal records, and clinical photographs to support the claim.
Benefit coordination: For patients with multiple insurance plans, coordinate benefits to optimize reimbursement and minimize patient expenses.
Appeal procedures: When claims are rejected, examine the benefits explanation, address rejection reasons, and file prompt appeals with additional evidence as required.
How dental practices use D6102
Practice Example: A 62-year-old patient shows bleeding, inflammation, and x-ray evidence of bone loss surrounding one lower jaw implant. Conservative treatment using local antibiotics failed to improve the condition. The specialist records a 6mm peri-implant pocket depth and visible threads. Surgical cleaning and bone reshaping are completed using local anesthesia, including comprehensive implant surface cleaning, tissue flap access, and closure. The treatment and clinical observations are thoroughly documented, with before and after photographs included with the insurance submission. The claim is filed with detailed explanation and supporting materials, achieving successful payment under D6102.
Through proper understanding of appropriate application, documentation requirements, and billing approaches for D6102, dental offices can secure accurate payment and deliver excellent patient treatment results.
Common Questions
Can code D6102 be applied to multiple implant sites during a single appointment?
D6102 must be reported separately for each implant site treated. When performing surgical debridement and osseous contouring on multiple implants in one visit, submit D6102 for every individual implant site that receives treatment. Your clinical documentation must clearly specify each implant location and detail the procedures performed at every site.
What are typical reasons insurance companies deny D6102 claims?
Insurance denials for D6102 commonly occur due to inadequate documentation, insufficient evidence demonstrating medical necessity for surgical treatment, or policy exclusions for implant-related services. To minimize denial risk, maintain detailed clinical records, include supporting radiographs and photographs, and provide clear justification explaining why non-surgical treatment options were insufficient.
What strategies work best when appealing a rejected D6102 claim?
For D6102 claim appeals, first examine the Explanation of Benefits to identify the specific denial reason. Prepare a comprehensive appeal package including a detailed cover letter, supplementary clinical documentation, current radiographs, and intraoral photographs. Clearly articulate the medical necessity for surgical intervention and directly address each concern mentioned in the denial notice. Success depends on prompt submission and thorough supporting evidence.