Ask the Coding Coach
I am confused about the correct coding when doing bone grafts, especially in edentulous areas. Can you help me determine which codes would be appropriate?
It can be confusing but changes in the CDT codes over the last few years have helped distinguish different codes for each scenario. Let’s place them in groups that will hopefully make their use clearer.
There are three categories that are included when bone grafts are performed: natural teeth, implants, and an edentulous ridge or socket.
Natural teeth (Periodontitis):
- D4263 bone replacement graft – retained natural tooth – first site in quadrant.
- D4264 bone replacement graft – retained natural tooth – each additional site in quadrant.
Note that if two contiguous teeth have separate osseous defects, these would be two sites and both codes would be used. If contiguous teeth have defects that communicate, such as interproximally, then this is considered the same site and only D4263 would be appropriate.
Implants:
- D6103 bone graft for repair of peri-implant defect – does not include flap entry and closure.
This code would be used with either D6101 or D6102 which is debridement of the implant with or without osseous contouring.
- D6104 bone graft at time of implant placement
If a bone graft is necessary when an implant is placed, this code is used in conjunction with D6010 surgical placement of implant body: endosteal implant.
Both codes differ from the codes for natural teeth in that they are for a single implant and can be used multiple times for the number of implants that are treated.
Edentulous ridge or socket:
- D7950 osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla – autogenous or non-autogenous, by report
Edentulous ridge augmentation is done when there are no teeth present, and the alveolar ridge requires additional width or height. This could be for such procedures as placement of an implant later or to improve the anatomy of the ridge in a pontic area before a bridge is placed.
- D7953 bone replacement graft for ridge preservation – per site
In this case, a tooth or implant has been extracted, and a bone graft is necessary to maintain the integrity of the alveolar ridge. The code is commonly used when a tooth is extracted, and an implant will be placed after healing. The implant is not placed at the time of the extraction.
Clinical examples:
Osseous surgery is performed on teeth #18-20. There is a vertical defect on the distal of tooth #18 and bone loss interproximal to the first molar and second premolar. After debridement and osseous contouring, bone grafts are necessary on #18 distal and #19-#20 interproximal. In this case, after coding for the osseous surgery (D4261) two additional codes are necessary, D4263 for #18-distal and D4264 for #19-#20 interproximal. Remember, if the defect is interproximal it counts as one defect and uses one code.
In the maxillary arch, osseous surgery is completed in the right quadrant. During the surgery, it was decided that the distomesial root should be removed on tooth #2, the last tooth in the quadrant. A defect resulted which requires grafting. In this case, D4263 should be used. The graft is not placed in an area where there is an edentulous ridge or in an extraction site of a tooth. It is placed around a tooth to repair the tooth, so D4263 is the correct code.
A patient has a hybrid implant denture in the mandibular arch. Two of the implants exhibit bone loss. The appliance is removed and the peri-implantitis is treated, including osseous contouring, bone grafts, and resorbable membranes around both implants. Appropriate codes would include D6102 x2, D6103 x2, and D6106 x2. Each implant procedure is coded separately.
Teeth #7-10 are missing related to an automobile accident. Implants are the treatment of choice; however, the alveolar ridge in the maxillary anterior region will require augmentation to increase the likelihood of implant integration. A flap is elevated, and bone grafts are placed with a resorbable membrane. Correct coding would be D7950 for the graft and D7956 for the membrane. Remember that D7950 is “by report” so a narrative for the procedure should be submitted with the claim.
Also confusing is the difference between D7953 and D6104. Both are used when an implant is to be placed. If the bone graft is done at the same time as the implant is placed, then D6104 should be used. If the implant is to be placed at a later appointment in an area where a tooth or implant is being removed, then D7953 is appropriate.
I hope this helps clarify coding for bone grafts. Remember the three categories and determine if you are treating a natural tooth, an implant, or an edentulous ridge. If you have questions, AAP’s Third-Party Specialist can provide guidance. Email [email protected] or call 312-573-3241.
Submit your third-party questions to [email protected]. Members with coding questions or difficulties with insurance claims can also contact the AAP’s Third-Party Specialist at 312-573-3241 or [email protected].
I am confused about the correct coding when doing bone grafts, especially in edentulous areas. Can you help me determine which codes would be appropriate?
It can be confusing but changes in the CDT codes over the last few years have helped distinguish different codes for each scenario. Let’s place them in groups that will hopefully make their use clearer.
There are three categories that are included when bone grafts are performed: natural teeth, implants, and an edentulous ridge or socket.
Natural teeth (Periodontitis):
- D4263 bone replacement graft – retained natural tooth – first site in quadrant.
- D4264 bone replacement graft – retained natural tooth – each additional site in quadrant.
Note that if two contiguous teeth have separate osseous defects, these would be two sites and both codes would be used. If contiguous teeth have defects that communicate, such as interproximally, then this is considered the same site and only D4263 would be appropriate.
Implants:
- D6103 bone graft for repair of peri-implant defect – does not include flap entry and closure.
This code would be used with either D6101 or D6102 which is debridement of the implant with or without osseous contouring.
- D6104 bone graft at time of implant placement
If a bone graft is necessary when an implant is placed, this code is used in conjunction with D6010 surgical placement of implant body: endosteal implant.
Both codes differ from the codes for natural teeth in that they are for a single implant and can be used multiple times for the number of implants that are treated.
Edentulous ridge or socket:
- D7950 osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla – autogenous or non-autogenous, by report
Edentulous ridge augmentation is done when there are no teeth present, and the alveolar ridge requires additional width or height. This could be for such procedures as placement of an implant later or to improve the anatomy of the ridge in a pontic area before a bridge is placed.
- D7953 bone replacement graft for ridge preservation – per site
In this case, a tooth or implant has been extracted, and a bone graft is necessary to maintain the integrity of the alveolar ridge. The code is commonly used when a tooth is extracted, and an implant will be placed after healing. The implant is not placed at the time of the extraction.
Clinical examples:
Osseous surgery is performed on teeth #18-20. There is a vertical defect on the distal of tooth #18 and bone loss interproximal to the first molar and second premolar. After debridement and osseous contouring, bone grafts are necessary on #18 distal and #19-#20 interproximal. In this case, after coding for the osseous surgery (D4261) two additional codes are necessary, D4263 for #18-distal and D4264 for #19-#20 interproximal. Remember, if the defect is interproximal it counts as one defect and uses one code.
In the maxillary arch, osseous surgery is completed in the right quadrant. During the surgery, it was decided that the distomesial root should be removed on tooth #2, the last tooth in the quadrant. A defect resulted which requires grafting. In this case, D4263 should be used. The graft is not placed in an area where there is an edentulous ridge or in an extraction site of a tooth. It is placed around a tooth to repair the tooth, so D4263 is the correct code.
A patient has a hybrid implant denture in the mandibular arch. Two of the implants exhibit bone loss. The appliance is removed and the peri-implantitis is treated, including osseous contouring, bone grafts, and resorbable membranes around both implants. Appropriate codes would include D6102 x2, D6103 x2, and D6106 x2. Each implant procedure is coded separately.
Teeth #7-10 are missing related to an automobile accident. Implants are the treatment of choice; however, the alveolar ridge in the maxillary anterior region will require augmentation to increase the likelihood of implant integration. A flap is elevated, and bone grafts are placed with a resorbable membrane. Correct coding would be D7950 for the graft and D7956 for the membrane. Remember that D7950 is “by report” so a narrative for the procedure should be submitted with the claim.
Also confusing is the difference between D7953 and D6104. Both are used when an implant is to be placed. If the bone graft is done at the same time as the implant is placed, then D6104 should be used. If the implant is to be placed at a later appointment in an area where a tooth or implant is being removed, then D7953 is appropriate.
I hope this helps clarify coding for bone grafts. Remember the three categories and determine if you are treating a natural tooth, an implant, or an edentulous ridge. If you have questions, AAP’s Third-Party Specialist can provide guidance. Email [email protected] or call 312-573-3241.
Submit your third-party questions to [email protected]. Members with coding questions or difficulties with insurance claims can also contact the AAP’s Third-Party Specialist at 312-573-3241 or [email protected].