b'FOR YOUR PRACTICEAsk the Coding CoachDear Coding Coach:What is the correct way to code when I elevate a flap on a tooth to determine if there is a fracture or root resorption? Correct coding will be determined by the end result of the procedure. For example, a maxillary second bicuspid exhibits an 8 mm pocket at the mesiobuccal line angle. There is no history of previous pocketing, and other pocket depths on this tooth, as well as others in the quadrant, show no depths greater than 3 mm. A fracture or crack is suspected, so a flap is elevated to evaluate and diagnose the problem. If a fracture is found and the tooth requires an extraction at the same appointment, this would be coded as an extraction. Based on the extraction, either D7140 [extraction, erupted tooth or exposed root (elevation and/or forceps removal)] or D7210 (extraction, erupted tooth requiring removal of bone and/or sectioning of tooth and including elevation of mucoperiosteal flap if indicated) would be the appropriate code. If resorption is present and requires treatment, the coding would be different. One option is to code for the flap usingNormally, a cover screw is placed at the time of implant placement D4241 (gingival flap procedure, including root planingone(D6010) so it would not be considered a separate procedure and to three contiguous teeth or tooth bounded spaces pernot fall under D6011. There are times when a healing cap is placed quadrant). The restoration would then be coded appropriately.on an implant at the time of placement, but this would not be Another option for coding when resorption is diagnosedconsidered a separate procedure for coding purposes. is to use either D3471, D3472, or D3473, which are forAfter the implant heals, and if tissue must be removed to gain surgical repair of root resorption, anterior, premolar, or molaraccess for placement of the healing cap, then that would be (respectively) in the endodontic category of the code set.considered a separate procedure and the patient would be charged These codes include elevating the flap but do not include thea fee. Remember that codes are for procedures, not techniques or restoration, so again, the appropriate code for the restorationmaterials, so D6011 should be used only if tissue must be removed should be added.to gain access to the implant. Common coding mistakes for this procedure include usingYou would be justified charging the patient for the second stage D4245 (apically positioned flap) or D4249 (clinical crownimplant surgery, but reimbursement by third party payers is based lengthening). In the described situation, neither code wouldon the patients plan. In many cases, D6011 is a plan limitation and be correct.will not be benefitted. The AAP always recommends getting a pre-Can I have a separate charge when I expose antreatment estimate for all claim submissions. implant and place a healing abutment after healing?There is a code for second stage implant surgery or surgical access to an implant body, D6011. The descriptor states that this procedure involves removal of tissue that coversSubmit your third-party questions to the implant body so that a fixture of any type can be placed,insurance@perio.org. Members with coding or an existing fixture be replaced with another. Examples ofquestions or difficulties with insurance claims fixtures include but are not limited to healing caps, abutmentscan also contact Pam Throw at 312-573-3241 shaped to help contour the gingival margins or the finalor email pamela@perio.org restorative prosthesis. AAP Periospectives| 33'