b'FOR YOUR PRACTICEAsk theCoding CoachI seem to have difficulty when submitting claimsD4231 (anatomical crown exposure - one to three teeth or for crown lengthening procedures. What is thebounded tooth spaces per quadrant)best way to avoid a denial for these? Anatomical crown exposure indicates that the CEJ of a tooth is First, lets recognize that there are procedures that aresubgingival. The tissue is healthy, without pocketing, and not very similar, but each has different codes to distinguishhyperplastic. Surgery involves removing soft tissue and supporting them: bone to the CEJ, which results in an anatomically correct gingival D4249 crown lengthening relationship between the soft tissue and the crown. Many times, this procedure is done for cosmetic reasons. An example is D4211 gingivectomy or gingivoplasty recontouring gingival tissue after completion of orthodontic D4212 gingivectomy or gingivoplasty to allow access fortreatment to create a more esthetic smile. restorative procedure D4241 (gingival flap procedure, including root planing - one to D4230 anatomical crown lengtheningthree contiguous teeth or tooth bounded spaces per quadrant)D4240 gingival flap procedure, including root planingWhen decay is present subgingivally and access cannot be Lets explore each one to highlight the differences. obtained to restore the area unless a flap is elevated, D4241 should be used. After the tissue is elevated, the caries is restored D4249 (clinical crown lengtheninghard tissue)without any bone being removed or recontoured. In most cases This procedure is performed when a restoration is to besuch as this, the restoration is placed while the flap is elevated and placed and the decay or fracture extends subgingivallybefore closure. The code for the type of restoration placed should impinging on the bone. There is no pocketing oralso be submitted.inflammation present. A full thickness flap is needed toThese cases can be difficult to justify for a carrier, even though the remove both hard and soft tissue, altering the crown tonecessity will be quite clear to the periodontist. First, although in root ratio, to allow the restoration. In most cases, thesome of these cases the patient has no periodontal disease, the restoration is completed later after healing occurs.area should be charted for pocket depths, mobility, recession, and D4211 (gingivectomy or gingivoplasty - one to threeany other periodontal information. A radiograph is also a necessity contiguous teeth or tooth bounded spaces per quadrant) in all cases, whether healthy or diseased. Carriers not only want to This code is appropriate when there is excess diseasedsee the decay or fracture radiographically, but also want to verify or hyperplastic soft tissue, whether a restoration isthat the tooth is periodontally sound with a good prognosis. If placed or not. For example, fibrotic tissue related to highdecay or fracture cannot be clearly seen on the radiograph, try a blood pressure medication is present. It normally involvesdifferent angle or version. For example, a vertical vs. a horizontal multiple teeth with scaling and root planing completedbitewing, or a periapical from a different perspective might show concurrently, but no flap is elevated, and the bone doesthe area more clearly. If the treatment is denied, then appeal the not require treatment. decision with new information. An intraoral photograph might help visualize the need for treatment. As a last resort, a photograph can D4212 (gingivectomy or gingivoplasty to allow access forbe taken during the surgery when the need for treatment is more restorative procedure, per tooth)obvious.Although it is very similar to D4211, D4212 is usedAs always, if carriers deny reimbursement after the initial when a single tooth is involved, and hyperplastic tissuesubmission and appeal, you can submit a complaint resolution and is removed specifically for placement of any type ofthe AAP can contact the carrier to further discuss the treatment for restoration. Again, no flap is elevated, and no osseousyou and your patient. surgery is performed. 22'