When is D6104 used?
The D6104 dental code applies to bone grafting procedures conducted during dental implant placement. This CDT code is utilized when bone enhancement is required to support proper implant stability and osseointegration. It's important to note that D6104 is exclusively for grafts performed concurrently with implant placement, not for separate or staged procedures. Dental professionals should not apply this code for grafts at extraction sites or ridge preservation procedures—these situations require different CDT codes, such as D7953 for bone graft for ridge preservation.
D6104 Charting and Clinical Use
Proper documentation is crucial for successful D6104 reimbursement. Clinical records must clearly document:
The clinical need for bone grafting during implant placement
The exact location and tooth number involved
The graft material type and amount utilized
Radiographic evidence demonstrating the augmentation requirement
Typical clinical situations include cases with inadequate bone volume or quality at the implant location, frequently resulting from prior tooth extraction, periodontal conditions, or injury. Recording the clinical justification and including before-and-after radiographic images will support your claim and minimize denial risks.
Billing and Insurance Considerations
Processing D6104 claims demands careful attention and proactive insurer communication. Consider these recommended practices for dental billing staff:
Confirm benefits: Numerous dental insurance plans treat bone grafting during implant placement as a separate benefit or may exclude coverage entirely. Always confirm benefits prior to treatment and record insurer responses in patient files.
Include supporting materials: Provide clinical documentation, radiographic images, and a detailed explanation of the graft's medical necessity. This improves claim approval chances.
Apply proper coding: Avoid procedure unbundling. Use D6104 only when grafting occurs during the same visit as implant placement.
Challenge rejected claims: When an Explanation of Benefits denies coverage, examine the denial rationale, enhance your appeal with additional evidence, and cite the CDT code description for D6104.
How dental practices use D6104
Practice Example: A 55-year-old patient requires a single implant for the lower right first molar position. Pre-treatment CBCT scans show inadequate buccal bone width. During the implant surgery appointment, the dentist places a particulate bone graft to enhance the site and ensure implant success. The treatment is recorded with comprehensive clinical documentation, marked radiographs, and a detailed explanation of medical necessity. The claim is filed using D6104 with all supporting documents included. Following initial insurance rejection, the practice files an appeal with supplementary documentation, achieving successful payment.
This case demonstrates the significance of complete documentation, appropriate code usage, and persistent follow-up in optimizing D6104 bone graft reimbursement during implant placement procedures.
Common Questions
Can D6104 be billed when bone grafting is done separately from implant placement?
No, D6104 is specifically intended for bone grafts performed simultaneously with dental implant placement during the same appointment. When bone grafting is completed at a separate visit, providers should use an appropriate alternative code that accurately represents grafting procedures performed in preparation for future implant placement.
Which bone graft materials are commonly utilized in D6104 procedures?
D6104 procedures typically involve various bone graft materials including autografts (harvested from the patient), allografts (processed donor bone), xenografts (bone derived from animal sources), and alloplasts (synthetic bone substitute materials). Material selection depends on the specific clinical circumstances and practitioner preference, with proper documentation required in the patient's treatment records.
Do most dental insurance plans require preauthorization for D6104?
Preauthorization requirements for D6104 differ among dental insurance carriers. Many insurers may mandate preauthorization or predetermination prior to treatment, particularly when implant-related procedures are classified as elective treatments. Providers should verify coverage requirements with the patient's insurance carrier before proceeding to prevent potential claim denials.