Understanding Dental Code D4267

When to Use D4267 dental code

The D4267 dental code refers to "Guided Tissue Regeneration – Nonresorbable Barrier, Per Site." This CDT code is used when a dentist or periodontist performs a guided tissue regeneration (GTR) procedure using a nonresorbable barrier membrane to encourage the regrowth of bone and tissue lost due to periodontal disease. D4267 is appropriate when there is a need to regenerate supporting structures around a tooth, typically in cases of advanced periodontal defects. It should not be used for procedures involving resorbable barriers (see D4266 for resorbable barriers), or for routine bone grafting without membrane placement.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful reimbursement. When billing for D4267, ensure the clinical notes clearly describe:

• The specific periodontal defect treated (e.g., intrabony defect, furcation involvement)
• The use of a nonresorbable barrier membrane, including type and placement site
• Pre- and post-operative radiographs or clinical photographs
• Detailed narrative explaining the medical necessity for GTR

Common clinical scenarios for D4267 include treatment of deep periodontal pockets with vertical bone loss, or furcation defects in molars where regeneration is critical to tooth stability. Always include periodontal charting and radiographic evidence to support the claim.

Insurance Billing Tips

Billing for D4267 requires attention to payer policies and documentation standards. Here are actionable steps for maximizing claim acceptance:

1. Verify coverage: Before treatment, verify with the patient’s insurance whether GTR procedures are covered, as some plans exclude regenerative therapies or have frequency limitations.
2. Submit comprehensive documentation: Attach clinical notes, radiographs, and a detailed narrative to the claim. Highlight the severity of bone loss and why a nonresorbable membrane was necessary.
3. Use correct coding: Ensure you are not confusing D4267 with similar codes such as D4266 (resorbable barrier) or D4265 (biologic materials). Accurate code selection prevents denials and delays.
4. Appeal denials: If you receive an EOB denying the claim, review the reason code, gather additional supporting documentation, and submit a timely appeal with a clear explanation of medical necessity.

Example Case for D4267

Consider a patient presenting with a Class II furcation defect on a mandibular molar, confirmed by probing and radiographs. After scaling and root planing, the periodontist determines that guided tissue regeneration with a nonresorbable membrane is indicated to restore lost bone and prevent tooth loss. The clinical team documents the defect, takes pre- and post-op images, and writes a detailed narrative. The claim is submitted with D4267, including all supporting documentation. Insurance initially denies the claim citing lack of necessity, but the office appeals with additional radiographs and a more detailed narrative, resulting in successful reimbursement.

This example highlights the importance of thorough documentation, correct code usage, and persistence in the claim process for D4267.