Understanding Dental Code D4285

When to Use D4285 dental code

The D4285 dental code is designated for a non-autogenous connective tissue graft procedure that includes both the recipient surgical site and the donor material, and is billed for each additional contiguous tooth, implant, or edentulous tooth position in the same area. This code is used when a patient requires soft tissue grafting to address issues such as root exposure, inadequate keratinized tissue, or preparation for prosthetic work, and more than one adjacent site is treated during the same surgical session. D4285 is always reported in conjunction with the primary graft code (often D4273 for the first site), and D4285 covers each additional contiguous site treated in the same quadrant or area.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful reimbursement of D4285. Clinical notes should clearly specify:

• The exact teeth, implants, or edentulous positions treated
• The indication for grafting (e.g., recession, lack of attached gingiva, or pre-prosthetic need)
• Details of the procedure, including the donor site, graft material used, and technique
• Pre- and post-operative photographs and periodontal charting

Common clinical scenarios include treating multiple adjacent teeth with recession defects or preparing a span of edentulous ridge for implant placement. For example, if a patient presents with recession on teeth #24, #25, and #26, D4273 would be used for the first tooth, and D4285 would be reported for each additional contiguous tooth.

Insurance Billing Tips

Maximizing reimbursement for D4285 requires a proactive approach:

• Pre-authorization: Always verify benefits and obtain pre-authorization, as many carriers require clinical justification and supporting documentation before approving soft tissue grafts.
• Accurate Coding: Pair D4285 with the primary graft code and ensure each additional site is truly contiguous. Non-contiguous sites should be billed separately.
• Detailed Attachments: Include clinical notes, periodontal charting, and clear photos with your claim to reduce the risk of denials or requests for additional information.
• Appeal Denials: If a claim is denied, review the EOB for the reason, supplement with additional documentation, and submit a timely appeal. Highlight the medical necessity and the number of contiguous sites treated.

Example Case for D4285

Case: A patient presents with severe gingival recession on teeth #22 through #27. The periodontist performs a connective tissue graft on all six teeth in one quadrant. The claim is coded as follows:

• D4273 for the first site (tooth #22)
• D4285 for each additional contiguous tooth (#23, #24, #25, #26, #27)

The clinical documentation includes pre-op photos, periodontal measurements, and a narrative explaining the functional and esthetic need for grafting. The insurance coordinator submits the claim with all supporting materials, and the payer approves reimbursement for all six sites after reviewing the comprehensive documentation.

By understanding when and how to use D4285, dental teams can ensure accurate billing, reduce claim denials, and optimize reimbursement for multi-site soft tissue graft procedures.