b'FOR YOUR PRACTICEAsk the Coding CoachI am uncertain about how to code when implants and natural teeth are both present. Is the implant included in the code submission for scaling and root planing? How do I determine how many teeth are involved for the correct code? This can get confusing when treating quadrants that have both natural teeth and implants. The first thing to remember is that when peri-implant disease is treated, it should be coded separately for each implant. These codes include:D6081 scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surfaces, without flap entry and closureD6101 debridement of a peri-implant defect or defects surrounding abenefit implants. Others may not reimburse treatment of peri-implant single implant and includes surface cleaning of the exposed implantdiseases at all. As usual, it is best to avoid problems by submitting a surfaces, including flap entry and closure pre-treatment estimate. D6102 debridement and osseous contouring of a peri-implantI attended a course at the Annual Meeting on the socket shield defect or defects surrounding a single implant and includes surface(or partial extraction) technique. The session did not discuss cleaning of the exposed implant surfaces, including flap entry andreimbursement for this procedure or how to appropriately closurecode for it. How should I submit to a carrier for this treatment? If these implant procedures are performed in conjunction withCurrently there is not a specific code for the partial extraction treatment of natural teeth, consider the entire situation to determinetechnique. A procedure must be supported by literature, taught in whether to use the scaling and root planing (SRP) code for 1-3 teethdental schools, and performed in private practice before a new code (D4342) or 4 or more teeth (D4341). First, count the implant as ancan be passed and placed into CDT code set. In the meantime, I edentulous space related to the teeth. In other words, if the implantsuggest using a combination of codes to describe the procedure you is in the last position in the quadrant, then only the teeth anterior to itare doing. First, I would use code D7210, which includes extraction of would be counted to determine if the coding should be 1-3 teeth or 4an erupted tooth requiring removal of bone and/or sectioning of tooth, or more teeth.and including elevation of mucoperiosteal flap, if indicated. I would also use code D6010, placement of an implant, and D6104, bone graft at Lets look at some examples when the implant falls within thetime of implant placement. These codes do not reflect exactly what quadrant- for example, at tooth position #20. If only teeth #18 andwas performed so consider including D7999, unspecified oral surgery #19 are treated, then the proper code would be D4342, for 1-3 teeth.procedure, by report. This would require a narrative explaining that a If teeth #18-21 are treated, with an implant still at tooth positionpartial extraction was done to preserve the buccal bone, preventing #20, then the code for SRP is still D4342, for 1-3 teeth, counting thecollapse of the buccal plate and enhancing implant integration. space with the implant as edentulous, and also include the code for treatment of the implant (D6081 if debridement only, or D6101Two pathways of reimbursement might result: a benefit for the surgical or D6102 if a surgical procedure with a flap was performed). If teethextraction is possible; or the entire procedure might be denied since a #18-22 are treated, with an implant still at tooth position #20, thenpartial extraction was done. It is strongly recommended to complete a code the SRP as D4341, 4 or more teeth, again counting the spacepre-treatment estimate prior to the surgery. with the implant as edentulous. And again, include the code forThe AAP has requested that a CDT code be created to accurately treatment of the implant.describe the partial extraction technique. If the code application is Implants should always be coded separately from natural teeth,accepted, it will go into effect in 2025.and you should not code for a procedure twice. Therefore, counting the implant space the same as an edentulous space would be appropriate.Submit your third-party questions to insurance@perio.org. Members with coding questions or Remember, however, that carriers are not required to reimburse bothdifficulties with insurance claims can also contact procedures. This will be determined by plan limitations. Some carriersthe AAPs Third-Party Specialist at 312-573-3241 will not reimburse treatment of peri-implant diseases unless they alsoor michellef@perio.orgAAP Periospectives| 27'