Understanding Dental Code D4240

When to Use D4240 dental code

The D4240 dental code is designated for the "gingival flap procedure, including root planing – four or more contiguous teeth or tooth bounded spaces per quadrant." This CDT code should be used when a patient requires surgical access to the root surfaces for thorough debridement due to moderate to advanced periodontitis. Unlike routine scaling and root planing (D4341), D4240 involves reflecting the gingival tissue to better visualize and clean the root surfaces and underlying bone. It is not appropriate for use in cases where only non-surgical periodontal therapy is performed or when fewer than four teeth in a quadrant are treated.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing D4240. Clinical notes should include:

• Periodontal charting showing pocket depths and attachment loss
• Radiographic evidence of bone loss
• Detailed narrative describing the need for surgical access (e.g., non-responsive to non-surgical therapy, persistent deep pockets)
• Specific teeth and quadrants treated
• Pre- and post-operative diagnoses

Common clinical scenarios for D4240 include patients with generalized moderate to severe periodontitis who have not responded to scaling and root planing, or when access for thorough root debridement is not possible without flap reflection. Always ensure that the clinical necessity for surgical intervention is clearly established in the patient record.

Insurance Billing Tips

When submitting claims for D4240, dental offices should follow these best practices to maximize reimbursement and minimize denials:

• Verify coverage: Confirm the patient’s periodontal benefits and frequency limitations before treatment.
• Submit comprehensive documentation: Include periodontal charting, radiographs, and a detailed narrative with your claim. Many payers require evidence that non-surgical therapy was attempted first.
• Use correct coding: Do not substitute D4240 for other procedures, such as osseous surgery (D4260), unless clinically indicated.
• Monitor EOBs: Review Explanation of Benefits statements for partial payments or denials, and be prepared to submit additional documentation or appeal if necessary.
• Track AR: Stay on top of outstanding claims in your accounts receivable to ensure timely follow-up and resolution.

Example Case for D4240

Case Example: A 52-year-old patient presents with persistent 6-7mm periodontal pockets in the upper right quadrant despite previous scaling and root planing. Radiographs reveal moderate horizontal bone loss. The periodontist determines that surgical access is necessary to remove subgingival calculus and granulation tissue. The clinical team documents the findings, obtains pre-authorization, and performs a gingival flap procedure on teeth #2–5. The claim is submitted with supporting documentation, and the insurance carrier approves payment for D4240 after reviewing the records.

This example highlights the importance of thorough documentation, proper case selection, and proactive insurance communication when billing for D4240.