Understanding Dental Code D3432

When to Use D3432 dental code

The D3432 dental code is used to report guided tissue regeneration (GTR) with a resorbable barrier, per site, in conjunction with periradicular surgery. This code is specific to procedures where a dentist or periodontist places a resorbable membrane to encourage the regeneration of bone and periodontal tissue around the roots of teeth during periradicular (root-end) surgery. D3432 should be used only when a resorbable barrier is placed and the procedure is performed in tandem with surgical intervention for endodontic pathology, such as apicoectomy or root-end resection. It is not appropriate for use with non-surgical procedures or when a non-resorbable barrier is used (see D4266 for non-resorbable barriers).

Documentation and Clinical Scenarios

Accurate documentation is essential for successful reimbursement of D3432. Clinical notes should include:

• Diagnosis and rationale for guided tissue regeneration in the context of periradicular surgery
• Details of the surgical procedure, including tooth number, site, and extent of the defect
• Type of resorbable barrier used (brand, material, and lot number if available)
• Pre- and post-operative radiographs showing the defect and surgical outcome
• Patient consent and explanation of the procedure

Common clinical scenarios include persistent periapical lesions, root-end defects, or bone loss around the apex of a tooth following failed root canal therapy. The use of a resorbable membrane helps prevent soft tissue ingrowth and supports bone regeneration, improving the prognosis of the surgical site.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D3432, dental billing teams should:

• Verify insurance benefits prior to treatment—many dental plans have limitations or exclusions for GTR procedures, especially when performed in conjunction with endodontic surgery.
• Submit comprehensive documentation with the claim, including clinical notes, radiographs, and a narrative explaining the medical necessity of GTR with a resorbable barrier.
• Use the correct CDT code (D3432) and avoid upcoding or miscoding. If a non-resorbable barrier is used, reference D4266 instead.
• Review EOBs (Explanation of Benefits) carefully for denial reasons and be prepared to submit appeals with additional documentation if needed.
• Track AR (Accounts Receivable) to ensure timely follow-up on unpaid or partially paid claims.

Successful practices often have a standardized checklist for GTR procedures to ensure all required documentation is gathered before claim submission.

Example Case for D3432

Case Example: A 45-year-old patient presents with a persistent periapical lesion on tooth #14 following previous root canal therapy. The endodontist recommends periradicular surgery with guided tissue regeneration. During surgery, a resorbable collagen membrane is placed over the bony defect to facilitate regeneration. The procedure is documented thoroughly, including pre- and post-op radiographs and a detailed narrative. The claim is submitted with D3432, and insurance approves payment after reviewing the comprehensive documentation.

This example highlights the importance of proper code selection, clinical documentation, and proactive insurance communication when billing for D3432.