Understanding Dental Code D4266

When to Use D4266 dental code

The D4266 dental code is designated for "Guided Tissue Regeneration – Resorbable Barrier, Per Site." This CDT code is used when a dentist or periodontist performs a surgical procedure to regenerate lost periodontal structures (such as bone and connective tissue) using a resorbable barrier membrane. D4266 is appropriate when treating periodontal defects caused by moderate to advanced periodontitis, especially in cases where bone loss threatens tooth stability. It should not be used for routine cleanings or minor gum treatments; its use is specific to regenerative procedures that require a membrane to facilitate tissue growth and healing.

Documentation and Clinical Scenarios

Accurate documentation is crucial for successful reimbursement of D4266. Clinical notes should detail the diagnosis (e.g., intrabony defect, furcation involvement), the specific site(s) treated, and the type of resorbable membrane used. Include pre- and post-operative radiographs, periodontal charting, and intraoral photos when possible. Common clinical scenarios for D4266 include:

• Regeneration of bone around teeth with deep periodontal pockets.
• Treatment of furcation defects in molars.
• Repair of bone loss following trauma or infection, when regeneration is possible.

Always ensure that the clinical narrative clearly justifies the need for guided tissue regeneration and the use of a resorbable barrier.

Insurance Billing Tips

Billing D4266 requires attention to detail and proactive communication with payers. Here are actionable steps for maximizing reimbursement:

• Insurance Verification: Before treatment, verify the patient’s periodontal benefits and any exclusions for regenerative procedures. Document the representative’s name and reference number for the call.
• Preauthorization: Submit a detailed preauthorization request with supporting documentation (diagnosis, radiographs, periodontal charting, and clinical narrative). This reduces the risk of claim denial.
• Claim Submission: On the claim form, list D4266 for each site treated. Attach all supporting documents and use precise, procedure-specific language in the narrative.
• Coordination of Benefits: If the patient has dual coverage, coordinate benefits to maximize reimbursement and minimize patient out-of-pocket costs.
• Claim Appeals: If denied, review the EOB for denial reasons, gather additional supporting evidence, and submit a timely appeal with a strong clinical justification.

Staying current with payer policies and maintaining thorough records are key to successful billing for D4266.

Example Case for D4266

Case Example: A 52-year-old patient presents with a 7mm intrabony defect on the mesial aspect of tooth #30. After comprehensive periodontal evaluation and radiographic confirmation, the periodontist determines that guided tissue regeneration is clinically indicated. During surgery, a resorbable membrane is placed to facilitate bone and tissue regrowth. The procedure, site, and materials are documented in detail, and pre- and post-op photos are included in the patient record. The insurance claim is submitted with D4266, a clear clinical narrative, and all supporting documentation, resulting in successful reimbursement.

For related procedures, such as guided tissue regeneration with a non-resorbable barrier, see D4267.