b'FOR YOUR PRACTICEAsk the Coding CoachDear Coding Coach: Following the same principles as the first example, the following codes would be appropriate: When a quadrant has a combination of natural teeth and implants, how should I code? If there are more Implants #18 and #19: D6102 (for each implant) debridement teeth in the quadrant than implants, should I just useand osseous contouring of a peri-implant defect or defects the periodontal codes?surrounding a single implant and includes surface cleaning of the exposed implant surfaces, including flap entry and closure. This is an excellent question and not easy to answer. First, Implant #18: D6103 bone graft for repair of peri-implant defectremember that you should always code for what you do, which may mean multiple codes for the same quadrant ordoes not include flap entry and closure.area. Lets look at a few examples of coding for a combination Implant #18: D4266 guided tissue regenerationresorbable of teeth and implants. barrier, per siteA patient has implants in the maxillary left quadrant in the Teeth #20 and #21: D4261 osseous surgery (including elevation areas of #13 and #15. #12, #13, and #14 are natural teeth.of a full thickness flap and closure)one to three contiguous An evaluation reveals pocketing of 5-6 millimeters withteeth or tooth bounded spaces per quadrant bleeding and edema on both implants. Tooth #14 also exhibits 45-millimeter pockets with inflammation. The treatmentAt this time, there is no code in the implant category to use when plan includes scaling and root planing for tooth #14, as wella barrier membrane is used for regeneration around an implant. as scaling and debridement of both implants. The correctThe periodontal codes D4266 and D4267 should be used. Again, a coding would be: carrier will most likely benefit the most inclusive procedure, which inTooth #14: D4342 periodontal scaling and root planing,this example is the osseous surgery. If implant coverage is included one to three teethin the plan, then the implant codes should be benefitted. If treatment of the implants is not covered, it most likely is a plan limitation, andImplants #13 and #15: D6081 (for each implant) scalingonly the osseous surgery for one to three teeth will be reimbursed.and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of theComplicated scenarios such as these only emphasize the implant surfaces, without flap entry and closure.importance of a pre-treatment estimate. Remember, too, that calling a patients carrier and inquiring about a plans coverage is not These three codes correctly describe what proceduresthe same as a pre-treatment estimate in writing. Ultimately, when are being performed. The procedures for implants differdetermining the correct coding in complicated treatments, take it in that they are applied per implant, so each implantstep by step, and code for what you do. should have its own code. You should not code focused on reimbursement. In these instances, the carrier will most likely benefit the most inclusive procedure, the scaling andADA CDT 2022 Code Changesroot planing. One additional piece of advice for this scenario would be that if only D4342 (scaling and root planing, oneSeveral new and updated CDT codes go into effect on to three teeth) is benefitted, it is recommended that theJanuary 1, 2022. See how these changes will affect clinician appeal to be reimbursed for four or more teeth sinceyour periodontal practice by going to AAP Connect the implants are included. There is no guarantee it will be Libraries AAP Member Resources Insurance changed, however, since each plan differs.Reimbursement and Third-Party Issues ADA CDT 2022 Changes. Be sure to review this resource Lets look at another example. In the mandible, teeth #20- periodically to stay up to date on procedure codes. 24 are present, with implants in the areas of teeth #18 and #19. The implants have bone loss evident radiographically, inflammation, and pocket depths of 6-7 millimeters. Teeth #20 and #21 also have moderate bone loss, inflammation, and pocketing of 5-6 millimeters. Osseous surgery will beSubmit your third-party questions to necessary for both the implants and the bicuspids. A bone graftinsurance@perio.org. Members with coding utilizing a membrane is treatment planned for implant #18.questions or difficulties with insurance claims can also contact Pam Throw at 312-573-3241 or email pamela@perio.org AAP Periospectives| 23'