b'FOR YOUR PRACTICEAsk the Coding CoachDear Coding Coach: If biologics are used:I am confused when submitting claims for peri-implantitis,#18 - D4265, biologic material to aid in soft and osseous tissue especially when it is treated in conjunction with periodontitisregeneration.around natural teeth. Can you give me some guidelines for#22 - D4265, biologic materials to aid in soft and osseous tissue correct coding?regeneration.It does get confusing when coding involves both implants and naturalTo code for the implant:teeth. First, lets talk about the implant category (the 6000-series codes). The codes for treating peri-mucositis and peri-implantitis#19 - D6102, debridement and osseous contouring of a peri-implant are codes for single implants, so each implant treated will requiredefect for defects surrounding a single implant and includes surface a separate code and is dependent on the procedure done. Forcleaning of the exposed implant surfaces, including flap entry and example, an implant supported bridge is present in the maxillary rightclosure.posterior from #2-5. The implant for #2 exhibits pocketing and bone#19 - D6103, bone graft for repair of peri-implant defect, does not loss. Debridement, a bone graft, and a resorbable membrane is theinclude flap entry and closure.treatment plan. The implant for #5 has inflammation but no bone loss radiographically, so a flap and debridement will be performed. Correct#19 - D4266, guided tissue regenerationresorbable barrier, per site.coding would include the following:There are a few important things to remember. First, the barrier #2 - D6102, debridement and osseous contouring of a peri-implantmembrane is coded per site. The definition of site is clearly defect or defects surrounding a single implant and includes surfacedefined at the beginning of the periodontal category of CDT, and it cleaning of the exposed implant surfaces, including flap entry andspecifically states that if the defects on teeth #18 and the implant closure.#19 communicate, this would be considered one site and only one #2 - D6103, bone graft for repair of peri-implant defect- does notmembrane should be submitted. include flap entry and closure. It is important to submit both since most carriers consider#2 - D4266, guided tissue regenerationresorbable barrier, per site. periodontal and implant surgery two separate procedures.A combination of osseous and implant codes also provides #5 - D6101, debridement of a peri-implant defect or defectsdocumentation in your records. surrounding a single implant, and surface cleaning of the exposedIt should also be stressed that carriers will normally only reimburse for implant surfaces, including flap entry and closure.the most inclusive procedure, in this case the D4260. The D6102 will Coding and reimbursement become more complicated when bothmost likely not be benefitted separately, but may be denied, allowing natural teeth and implants are being treated. An example would be thethe patient to be billed. This would depend on the plan. correct coding for the mandibular left quadrant, where periodontitis isUltimately, coding for a combination of implants and natural teeth can present on more than four teeth, and an implant exists replacing toothbe confusing, but always code for what you do. The AAP recommends #19. Regeneration is needed on teeth #18 and #22 as well as thetaking it one step at a time and work through the procedures that implant. Appropriate coding would be as follows:have been done, coding accordingly. And last, but by no means least, Teeth #18-23 - D4260, osseous surgery (including elevation of fullsend in a pre-treatment estimate. It will help eliminate many questions thickness flap and closure) four or more contiguous teeth or toothand clarifies coverage with the patient as well as the dentist. You can bounded spaces per quadrant. also always contact the Academy for assistance with pre-treatment estimates or insurance claims.#18 - D4263, bone replacement graftretained natural tooth- first site in quadrant. #22 - D4264, bone replacement graftretained natural tootheachSubmit your third-party questions to additional site in quadrant.insurance@perio.org. Members with coding questions or difficulties with insurance claims#18 - D4266, guided tissue regenerationresorbable barrier, per site.can also contact Pam Throw at 312-573-3241 #22- D4266, guided tissue regenerationresorbable barrier, per site.or email pamela@perio.org AAP Periospectives| 23'