Not all codes related to bone grafts are created equal. You must be aware of when to report the correct code for a bone graft, and knowing which code to use is entirely dependent upon the primary procedure being performed at the same visit.
Bone grafts for live/natural teeth
D4263: Retained natural tooth first site – usually reported in conjunction with periodontal surgery
D4264: Reported for each additional bone graft tooth
Bone grafts for peri-implantitis surgery
D6103: Bone graft for repair of peri-implant defect – usually reported when a patient is suffering from an implant with bone loss and infection.
D6102: Would be reported together with D6103 if treatment includes debridement or osseous contouring of the infected implant
Bone graft during implant placement
D6104: Bone graft at time of implant placement – reported only when an implant (D6010) is being placed in the same tooth number on the same visit.
Bone graft during an extraction of a natural/live tooth or dental implant
D7953: Bone replacement graft for ridge preservation – reported on the same visit as a tooth extraction (D7140/D7210) or the removal of a dental implant (D6100)
The codes above do not include tissue regeneration or placement of such materials. A narrative with x-rays can be helpful in facilitating claim payment—tooth number, treatment performed, and why the treatment was necessary should be documented in the patient's chart and narrative.
You should always send in a pretreatment authorization, including radiographs and periodontal charting, to ensure a smooth claim determination process.
Happy coding!
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