Coding with Kyle: D4265—Biologic materials to aid in soft and osseous tissue regeneration

Oct. 16, 2019
Coding so your practice can be properly reimbursed for treatment can be a bit tricky. This monthly column can help clarify some things. Here Kyle provides clarification for D4265.
Kyle L. Summerford, Editorial Director

Purpose: These materials are used during periodontal surgery to help stimulate regeneration of bone and soft tissue. Submitting the claim with x-rays is not enough to facilitate coverage and payment.

 This code should be applied only when the procedure involves placement of such materials during periodontal surgery.

 Dental insurance companies will refer to the patient plan limitations and exclusions when considering the dental claim.

This procedure may be reimbursed if no other regenerative procedures were billed on the same day.

 If reporting a restorative procedure on the same tooth and on the same day as crown lengthening, the claim will be denied for payment.

 A narrative should be included that indicates what materials were in fact used on the patient, i.e., GEMS 21, Emdogain, etc.

If barrier membranes were placed in conjunction, these should be reported using their appropriate ADA CDT codes.

 Pre-op and post-op x-rays must always accompany the claim form, and in addition, periodontal charting should be included.

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