SCALPELS-LASERS-ELECTROSURGE
CODING THE REMOVAL OF SOFT TISSUE
There are numerous situations in which dentists
charge for the removal of soft tissue. The codes used
and payments received from dental plans vary depending
on the clinical reason for the procedure, rather than
the technology used.
When Needed for Periodontal Treatment...
It does not matter if a scalpel or a laser is used.
If gum tissue is removed to reduce pocket depths to
enable more thorough oral hygiene, the procedure is
billed as a gingivectomy using D4210 if performed
on four or more teeth in the quadrant (or D4211 if
only one to three teeth are involved). In regards
to insurance reimbursement, dental plans often pay
for gingivectomies if required for the treatment of
Type II periodontal disease. Most dental plans will
require a diagnosis and current pre-operative, six-points-per-tooth
periodontal charting showing 4-6 mm pocket depths.
Some plans, including many Deltas, specifically require
5 mm pocket depths. If a narrative is provided describing
the clinical conditions addressed by the procedure,
radiographs may not be required. Also note that many
dental plans will not pay for a gingivectomy on the
same day as root planing and scaling or osseous surgery.
When Needed for Restorative Access...
CDT 2005 revised the descriptor for D4210/D4211 clarifying
that a gingivectomy may also be performed, “...to
allow access for restorative dentistry in the presence
of suprabony pockets, and to restore normal architecture
when gingival enlargements or asymmetrical or unaesthetic
topography is evident with normal bony configurations.”
This revision broadens the scope of D4210/D4211. The
code can clearly be used for both periodontal and
restorative reasons. While many dental plans will
consider payment for a gingivectomy when needed to
access subgingival caries, most will not pay for the
removal or recontouring of soft tissue for cosmetic
reasons. As such, we see many carriers now requiring
an x-ray or photo as well as a narrative proving that
the procedure has not been performed for cosmetic
reasons. It is important to also note that many carriers
will deny D4210/D4211 if performed on the same day
as a crown prep because they assume it is being done
for cosmetic reasons and consider it to be part of
your crown fee.
When Needed for Isolation of Teeth...
When it is not possible to place a rubber dam because
a cusp has fractured off 1-2 mm above the gingival
margin, soft tissue recontouring with a laser, scalpel,
or electro surgery often allows for placement of a
rubber dam clamp. In this situation, the removal or
recontouring of soft tissue is billed using D3910
(surgical procedure for isolation of tooth with rubber
dam). In regards to reimbursement, some dental plans
will require a narrative for payment while others
will consider it part of the procedure performed.
Non-participating providers, however, can charge the
patient since D3910 is not normally required to accomplish
most endodontic or restorative procedures.
When Needed Due to Gingival Hyperplasia...
Certain drugs and medications can cause gingival hyperplasia,
especially in patients who do not brush their teeth
regularly. Dilantin, a drug used to treat seizures
in epileptics, is known to cause overgrowth of the
gums as are certain other commonly used medications,
such as Cardizem (blood pressure medication), birth
control and hormone replacement drugs, and immunosuppressive
agents, such as cyclosporine. When drug-induced gingival
hyperplasia involves the entire arch, D7970, excision
of hyperplastic tissue-per arch, is the code that
should be billed along with a narrative. If not covered
under the patient’s dental plan, coverage may
be available under medical.
