b'FOR YOUR PRACTICEAsk theCoding CoachBased on feedback from past complaint resolutions, asThese soft tissue graft codes also apply to edentulous well as questions that are asked at the AAPs insuranceareas that have soft tissue grafting. In the case of an workshops, certain issues with carriers arise frequently.edentulous area, grafts are considered by site, which is Offices can avoid some of these issues, reducingthe equivalent of two tooth areas. It may be contiguous frustrations by making sure claims are sent correctlywith teeth or implants if the graft is placed at the same with adequate documentation. Lets review thesetime. common mistakes so that claims can be submitted more effectively, resulting in more efficient payments andAlso related to soft tissue grafting are denials based fewer frustrations. on the prognosis of a tooth or implant. Carriers request a radiograph to verify the prognosis of the tooth or One of the most frequent mistakes made involves softimplant being treated. Make sure that the radiograph tissue grafts. There seems to be confusion related tois of diagnostic quality to prevent delays in processing. which codes to use when multiple teeth or implants areAlthough carriers in most cases do not require a grafted, regardless of the type of graft. It does not matterphotograph, the AAP highly recommends a photo of how many teeth or implants are grafted; each shouldareas to be grafted. Photos can aid in justification of the have its own code for the soft tissue graft. The key in thesoft tissue graft either during the initial claim or a later use of these codes is the word contiguous. The firstappeal. tooth or implant in the area should have the correct code used depending on the type of graft place: The most common complaints are related to scaling and D4273 Autogenous connective tissue graft procedure root planing (SRP). Although most offices understand the need for charting and radiographs for claims D4275 Non-autogenous connective tissue graftinvolving SRP, the quality of the documentation is a procedurefactor. Periodontal charting always needs to be legible, D4277 Free gingival graft procedurebut radiographs are more often the issue. Carriers want to see radiographic bone loss in the areas of SRP. This If multiple teeth or implants are grafted, are these thecan be difficult with panoramic radiographs, which next tooth or implant sequentially in the arch? If so, thendo not show enough detail, or even with horizontal the codes for each additional contiguous tooth or implantbitewings, which may not show enough root surface. should be used: Periapical radiographs are the gold standard for viewing D4283 Autogenous connective tissue graft procedurebone loss. If an isolated area is being treated, provide each additional tooth or implantat least a periapical radiograph of that area. Diagnostic quality vertical bitewings may be acceptable under D4285 Non-autogenous connective tissue graftcertain circumstances. The key is to provide evidence procedure each additional tooth or implant of bone loss, which is considered objective, rather than D4278 Free gingival graft procedure each additionalpocket depths alone, which can be subjective. tooth or implant There has also been confusion regarding D4355, full For example, if teeth #3, #4, and #5 are grafted, thenmouth debridement. Previously, no evaluation could D4275 would be used one time and D4285 would bebe performed at the same appointment after a full used twice. However, if it includes teeth #3, #4, andmouth debridement was completed. The criteria have #6 then the correct codes would be D4275, D4285,changed, and at this time some evaluations, including and another D4275 since teeth #4 and #6 are nota comprehensive oral evaluation, a periodic evaluation, contiguous.or a problem-focused evaluation can be completed the30'