Understanding Dental Code D4273

When to Use D4273 dental code

The D4273 dental code is designated for the autogenous connective tissue graft procedure, which includes both donor and recipient surgical sites for the first tooth, implant, or edentulous tooth position in the graft. This CDT code is used when a periodontist or dentist harvests connective tissue—typically from the patient’s palate—and transplants it to another area in the mouth to treat gingival recession, increase attached gingiva, or prepare a site for future restorative work. D4273 should be reported only for the first site treated during a single surgical session; additional sites may require a different code, such as D4277 for each additional site.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful claim submission and reimbursement. Clinical notes should clearly describe:

• The diagnosis and clinical need for the graft (e.g., root exposure, inadequate keratinized tissue).
• The specific donor and recipient sites, including tooth numbers or edentulous areas.
• The surgical technique used and the amount of tissue harvested.
• Pre- and post-operative photos or radiographs, if available, to support the necessity of the procedure.

Common clinical scenarios for D4273 include treating advanced gingival recession around a single tooth, preparing an implant site with insufficient soft tissue, or augmenting tissue in an edentulous area prior to prosthetic placement.

Insurance Billing Tips

Billing for D4273 requires attention to detail and proactive communication with payers. Here are best practices:

• Insurance Verification: Before treatment, verify the patient’s benefits for periodontal surgery and grafting. Not all plans cover soft tissue grafts, and some may require prior authorization.
• Claim Submission: Submit a detailed claim with the D4273 code, supporting clinical documentation, and any required radiographs or photos. Clearly indicate the tooth number or edentulous area involved.
• EOB Review: Carefully review Explanation of Benefits (EOBs) for payment accuracy. If the claim is denied, check for missing documentation or benefit limitations.
• Appeals Process: If necessary, submit a claim appeal with additional clinical justification, including before-and-after images and a narrative explaining the medical necessity of the graft.

For cases involving multiple graft sites, ensure you use the correct codes for each additional site, such as D4277 for additional connective tissue grafts.

Example Case for D4273

Consider a patient presenting with significant gingival recession on tooth #24, resulting in root sensitivity and risk of further tissue loss. After insurance verification confirms coverage for D4273, the periodontist documents the clinical findings, captures pre-op photos, and explains the procedure to the patient. During surgery, connective tissue is harvested from the palate and grafted to the recipient site. The procedure is thoroughly documented, including tooth number, surgical technique, and post-op instructions. The claim is submitted with D4273, clinical notes, and photos, resulting in successful reimbursement after EOB review.

By following these steps and maintaining thorough documentation, dental teams can maximize reimbursement and ensure compliance when billing for D4273 connective tissue graft procedures.