I currently contract with an office that recently filed a claim for procedure code D4211 gingivectomy. Delta Dental denied claim because gums had SRP’S done earlier this year. I saw that gingivectomy has other codes assoicated with it one being D4212 which I think is coded when procedure is done to remove gum tissue for a restoration. Do you think they can use that code or was the correct code used since they had perio treatment done earlier this year?

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  • I currently contract with an office that recently filed a claim for procedure code D4211 gingivectomy. Delta Dental denied claim because gums had SRP'S done earlier this year. I saw that gingivectomy has other codes assoicated with it one being D4212 which I think is coded when procedure is done to remove gum tissue for a restoration. Do you think they can use that code or was the correct code used since they had perio treatment done earlier this year?

I currently contract with an office that recently filed a claim for procedure code D4211 gingivectomy. Delta Dental denied claim because gums had SRP’S done earlier this year. I saw that gingivectomy has other codes assoicated with it one being D4212 which I think is coded when procedure is done to remove gum tissue for a restoration. Do you think they can use that code or was the correct code used since they had perio treatment done earlier this year?

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Asked on November 11, 2014
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D4212 is to be used when you need access for a restorative procedure such as crown or filling. This is not to be used to remove large pockets in gum tissue. Whitout reviewing the providers notes of treatment performed we may suggest that If RPS was performed a more appropriate code for removal of large pockets in the gum would be D4261. Please note the providers documentation should match up with the procedure code prior to filing any claims.

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Answered on November 12, 2014
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