Understanding Dental Code D4276

When to Use D4276 dental code

The D4276 dental code is designated for a combined connective tissue and double pedicle graft, performed per tooth. This CDT code is used when a periodontist or general dentist completes a soft tissue grafting procedure that involves both harvesting connective tissue (often from the patient’s palate) and repositioning adjacent gum tissue (pedicle flaps) to cover exposed root surfaces or augment thin gingiva. D4276 is distinct from other grafting codes because it specifically describes the combined use of both techniques on a single tooth, which is typically indicated for advanced recession or complex periodontal defects where single-method grafting would not provide optimal results.

Documentation and Clinical Scenarios

Accurate documentation is critical for successful reimbursement when billing D4276. The clinical notes should clearly state:

• The specific tooth or teeth treated
• Pre-operative diagnosis and reason for grafting (e.g., Miller Class III recession, inadequate keratinized tissue)
• Details of the procedure, including the source of connective tissue and the creation of double pedicle flaps
• Pre- and post-operative photos, periodontal charting, and radiographs as supporting evidence

Common scenarios for D4276 include treating teeth with significant root exposure, especially in esthetic zones, or when previous single-method grafts have failed. This code should not be used for simple free gingival grafts (D4277) or single pedicle procedures (D4278).

Insurance Billing Tips

To maximize reimbursement for D4276, dental billers should follow these best practices:

• Verify patient benefits before treatment, as many plans have limitations on periodontal grafting procedures or require specific documentation.
• Submit a detailed narrative with the claim, describing the clinical need for both connective tissue and double pedicle techniques.
• Include all supporting documentation (photos, perio charting, radiographs) with the initial claim to reduce the likelihood of a request for additional information or a denial.
• If the claim is denied, appeal promptly with additional clinical justification and reference to the CDT code definition.
• Track claims in your AR system and follow up regularly to ensure timely payment.

Remember, insurance carriers may bundle or downcode grafting procedures, so clear documentation and proactive communication with payers are essential.

Example Case for D4276

Consider a patient presenting with severe recession on tooth #8, with inadequate keratinized tissue and prior unsuccessful single-method grafting. The periodontist documents the need for a combined approach, harvesting connective tissue from the palate and creating double pedicle flaps from adjacent teeth. Pre- and post-op photos, detailed clinical notes, and a narrative explaining the complexity are submitted with the claim. The insurance carrier initially requests more information, but the office promptly supplies additional documentation, leading to claim approval and full reimbursement for D4276.

This example highlights the importance of thorough documentation, clear communication, and diligent follow-up in successfully billing for complex periodontal procedures using the D4276 dental code.