b'FOR YOUR PRACTICEAsk the Coding CoachI am doing a maintenance procedure on aplace a bone graft and membrane for regeneration. Since the new patient with a hybrid appliance utilizing fourcodes for 2023 have individual codes in the periodontal and oral implants in the mandible and natural teethsurgery categories for membrane use, should I utilize the code for in the maxilla. We will need to remove theperiodontal defects or edentulous areas, since both are involved? appliance and debride the implants at the same appointment as periodontal maintenanceThis is a good question, and I can see how this causes confusion. I would in the maxilla. What would be the correctrecommend evaluating the primary cause for the regeneration procedure. In coding for these procedures?this case, the bone loss was caused by a periodontal defect with the tooth being retained. As a result, a periodontal defect is being addressed. If the Because you are performing periodontal maintenancetooth was extracted and regeneration performed, then the treatment would be on the maxillary teeth, D4910, periodontaladdressing the extraction site and thus the edentulous ridge. So based on your maintenance, would be billed for the maxillary arch.treatment, coding would be D4263, bone replacement graft -retained natural The procedure for the mandibular arch is significantlytooth, first site in quadrant, and D4266, guided tissue regeneration, natural different and should be coded separately. In thisteethresorbable barrier, per site (or D4267 if it is a non-resorbable barrier). case, D6080, implant maintenance procedures when prostheses are removed and reinserted, includingIf a tooth is extracted, on the other hand, then the new codes would be cleansing of prostheses and abutments, would beappropriate: D7953, bone replacement graft for ridge preservationper site, used because the hybrid appliance is being removed.and D7956, guided tissue regeneration, edentulous arearesorbable barrier, The D6080 code descriptor specifically states thatper site (or D7957 for a non-resorbable barrier). the procedure includes active debriding of theRemember also that there are now codes for membranes that are used implant(s) and examination of all aspects of thesurrounding implants. These include D6106, guided tissue regenerationimplant(s) systems. The other code used would beresorbable barrier, per implant, and D6107, guided tissue regenerationnon-D6197, replacement of restorative material used toresorbable barrier, per implant. close an access opening of a screw-retained implant supported prothesis, per implant. Since this hybridIf any of the non-resorbable barrier codes are applied (D4267, D6107, or appliance utilizes four implants, D6197 would beD7957), there is a new code for membrane removal when it is performed: coded four times when the appliance is reinserted,D4286, removal of non-resorbable barrier. the implant screws are torqued, and the openings are closed with restorative material. To summarize the appropriate coding: Maxilla:D4910Do you have coding questions or Mandible:D6080difficulties with insurance claims? Contact D6197 x4Michelle Flesch at 312-573-3241 or I am performing a root amputation on aemail michellef@perio.orgmaxillary first molar (#3), removing the distobuccal root. The patient is missing teeth #1 and #2. The bone loss surrounding the removed root is significant, so I plan to AAP Periospectives| 21'