Hi Jenna!

D4277 = free soft tissue graft procedure (including donor site surgery), first tooth or edentulous tooth position in graft

D4278 - free soft tissue graft procedure (including recipient and donor surgical sites) each additional contiguous tooth, implant or edentulous tooth position in same graft site

The codes listed above do not have direct crosscodes we are aware of, so you can either bill the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), or you can try the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures


Hope this helps!

Hi Jenna!

I am not aware of limit - the description of D4278 does specify "each additional contiguous tooth", so I believe you can bill a unit for each contiguous tooth. You may consider using the JP qualifiers on the claim when billing this - i.e. if you have 3 unit, you can use the JP qualifier to indicate on the line item the tooth number. Here is some additional information about the JO and JP qualifiers:

The following are the codes for tooth numbers, reported with the JP qualifier:
• 1 –32: Permanent dentition
• 51 –82: Permanent supernumerary dentition
• A –T: Primary dentition
• AS –TS: Primary supernumerary dentition

The following are the codes for areas of the oral cavity, reported with the JO qualifier:
• 00 : Entire oral cavity
• 01 : Maxillary arch
• 02 : Mandibular arch
• 10 : Upper right quadrant
• 20 : Upper left quadrant
• 30 : Lower left quadrant
• 40: Lower right quadrant

Examples of how this would look on the medical claim can be found in the NUCC's CMS 1500 claim form manual here, starting on page 46 & 47:
http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v5.pdf

Hope this helps!

Hi Guest!

Great question. Dental coding is really not our forte like medical coding is - but yes it does appear that D4277 (free soft tissue graft procedure (including donor site surgery), first tooth or edentulous tooth position in graft) is still active. It does appear that code's description was revised in 2016 or so, but still active.

That code not be listed as a covered benefit may likely just be the way that policy is designed. As for the other two codes you mentioned:

D4273 - autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant, or edentulous tooth position in graft

D4275 - non-autogenous connective tissue graft (including recipient site and donor material) first tooth, implant, or edentulous tooth position in graft


Hope this helps!

Hi Guest!

D4277 - free soft tissue graft procedure (including donor site surgery), first tooth or edentulous tooth position in graft
D4278 - free soft tissue graft procedure (including recipient and donor surgical sites) each additional contiguous tooth, implant or edentulous tooth position in same graft site

You can certainly bill these services to medical, but of course whether or not they will be covered by medical depends on the situation/diagnosis. In order for medical to cover, the case does need to be considered medical in nature rather than dental in nature.

For procedures that are typically dental in nature, they cross over to the medical in nature realm in situations such as accidental injury/trauma, tumor/cyst removals, and functional impairment, for example.

Hope this helps!

Hi Kimm!

Great question. For medical claims, instead of listing the same code multiple times, you would list it just once and indicate the fee for all procedures on that line item, and the use the JP or JO qualifier in the supplemental information are of the claim - JP to indicate tooth numbers, or JO to indicate areas of the oral cavity for services not tooth # related.

An example of how to use the JP qualifier on the medical claim can be found int he NUCC's claim form manual on page 48, here is a link to it:
https://nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2021_07-v9.pdf


So, for the coding scenario listed, it would be:

JP23 24 25
*for D4277

JP24 25 26
*for D4278

Hope this helps!