Correctly Documenting Code D4210! It’s in the Bank!

Estela Vargas, CRDH, CEO Remote Sourcing

Code: D4210 Gingivectomy or Gingivoplasty-Four or More Contiguous Teeth or Tooth Bounded Spaces Per Quadrant

The dentist executes the procedure to remove suprabony pockets or to regain normal architecture when the gingival enlargements or asymmetrical or unaesthetic topography is evident with normal bony configuration.

Note: The code D4210 reports a gingivectomy or a gingivoplasty. The description must coincide with the code descriptor in the current CDT 2023 Manual. Please note the procedure described in the narrative or clinical notes to differentiate one from the other.

 A gingivectomy includes the excision of the gingiva to reduce hypertrophy or to improve asymmetrical or unaesthetic gingival topography. A gingivoplasty is surgically reshaping the gingiva.

Two applications for this code that are often overlooked are for orthodontic cases and for patients on medications that cause the overgrowth of the gingiva.

For instance, if the patient is taking calcium channel blockers, you can document the gingiva enlargements as a product of the medication, which will be paid for! The following drugs have proven to cause side effects of overgrowth of the gingiva.

Amlodipine (Norvasc)

Diltiazem (Cardizem, Tiazac, others)

Felodipine.

Isradipine.

Nicardipine.

Nifedipine (Procardia)

Nisoldipine (Sular)

Verapamil (Calan SR, Verelan)

In the case of D4210, Orthodontists should pre-authorize the treatment per quadrant. Once approved, they can enter the date treatment was completed and mail/fax back to the insurance.

Required Documentation: Provide quality and labeled intraoral images of the overgrown gingiva and complete perio charting within the last three months; it cannot be older. With perio charting, it will get paid. Most importantly, clinical symptoms. The clinical signs (charted) will provide the insurance company with the medical necessity to qualify the patient to receive benefits for the code.

Rationale: In your clinical notes, where you diagnose the need for the procedure, D4210 states that it is necessary to eliminate suprabony pockets and restore standard architecture.

Make note if the patient cannot properly clean their teeth because of suprabony pockets, gingival inflammation, bleeding, and PAIN. The word PAIN is vital if the patient complains about it.

This code is a covered benefit for most plans. You'll need to give them the documentation and rationale to explain why it's necessary, so the claim is paid with the first submittal.