b'FOR YOUR PRACTICEAsk theCoding CoachI performed exposure of an impacted maxillaryPlacement of an attachment on an unerupted tooth, after canine and placed an orthodontic bracket at theits exposure, to aid in its eruption. Report the surgical time of surgery. When we submitted for insuranceexposure separately using D7280. In both cases, treatment reimbursement, payment was denied based onis considered part of the orthodontic therapy, so benefits plan limitations. Is there anything we can do to getare applied under the plans orthodontic policy. Most plans benefits?have a lifetime maximum for orthodontic reimbursement, Receiving benefits for procedures related to orthodonticwhich is usually reached when the orthodontist collects treatment can be difficult. The most obvious rationale isbenefits. By the time the patient is seen for these that the procedure is performed for esthetic purposes.procedures, reimbursement will be denied because the For example, after completion of orthodontic treatment,maximum allowable benefit has been reached even though a gingivectomy may be performed to obtain a more idealthe procedure itself may be periodontal or oral surgery. contour and/or crown to root ratio, especially for anteriorIt is always best to obtain a pre-treatment estimate teeth. The code for this procedure is:before these procedures, making it clear to the patient D4230 anatomical crown exposure, four or morethat the procedures may not be reimbursed and are the bounded teeth or responsibility of the patient. bounded tooth spacesThis procedure is utilized in an otherwise periodontallyA teenage patient was referred to me from their healthy area to remove enlarged gingival tissue andorthodontist. The patient was missing tooth #28 supporting bone (ostectomy) to provide an anatomicallycongenitally, resulting in very little height or width correct gingival relationship, orof the edentulous area. The orthodontist wants to D4231 anatomical crown exposure 1-3 teeth orpreserve the bone for implant placement when the bounded tooth spaces patient is 18. I submitted for a ridge augmentation to preserve the site, D7953, but reimbursement was This procedure is utilized in an otherwise periodontallydenied by the carrier. Is there anything I can do healthy area to remove enlarged gingival tissue andabout this? supporting bone (ostectomy) to provide an anatomically correct gingival relationship. This question seems like a very straight forward one that should have any easy answer. First, the coding for the These cases are primarily considered esthetic orprocedure that was submitted is incorrect. In all cases, cosmetic and as a result, most carriers will deny benefitsmake sure you understand a code, reading the descriptor even though they are performed related to orthodonticas well as the nomenclature. therapy. The code submitted was:Another common procedure performed in conjunction with orthodontic treatment is:D7953 bone graft for ridge preservation, per siteD7280 exposure of unerupted toothGraft is placed in an extraction or implant removal site at the time of extraction or removal to preserve ridge An incision is made, the tissue is reflected, and boneintegrity (e.g. clinically indicated for preparation for is removed as necessary to expose the crown of animplant reconstruction or where alveolar contour is impacted tooth not intended to be extracted.critical to planned prosthetic reconstruction.) Does not This is completed many times in conjunction with:include obtaining graft material. Membrane, if used, D7283 placement of device to facilitate eruptionshould be reported separately. of impacted tooth18'