Proper Coding for Bone Grafts

Bone Grafts and CDT Codes*

D3428, Bone Graft in Conjunction With Periradicular Surgery – per tooth, single site.
- CDT descriptor: "Includes non-autogenous graft material."
D3429, Bone Graft in Conjunction With Periradicular Surgery – each add'l contiguous tooth in same surgical site.
- CDT descriptor: "Includes non-autogenous graft material."

D4263, Bone Replacement Graft – retained natural tooth - first site in quadrant.
- CDT descriptor: "This procedure involves the use of grafts to stimulate periodontal regeneration when the disease process has led to a deformity of the bone. This procedure does not include flap entry and closure, wound debridement, osseous contouring, or the placement of biologic materials to aid in osseous tissue regeneration or barrier membranes. Other separate procedures delivered concurrently are documented with their own codes. Not to be reported for an edentulous space or an extraction site."
D4264, Bone Replacement Graft – retained natural tooth - each additional site in quadrant.
- CDT descriptor: "This procedure involves the use of grafts to stimulate periodontal regeneration when the disease process has led to a deformity of the bone. This procedure does not include flap entry and closure, wound debridement, osseous contouring, or the placement of biologic materials to aid in osseous tissue regeneration or barrier membranes. This procedure is performed concurrently with one or more bone replacement grafts to document the number of sites involved. Not to be reported for an edentulous space or an extraction site."
Note: These are not grafts in extraction sites, grafts for ridge preservation, grafts in endo/periradicular sites, grafts in implant removal sites, grafts done in implant placement sites, or grafts to enhance an edentulous sites.

D6103, Bone Graft for Repair of Periimplant Defect.
- CDT descriptor: "Placement of a barrier membrane or biologic materials to aid in osseous regeneration, are reported separately."
- Does not include flap entry and closure. Placement of a barrier membrane or biologic materials to aid in osseous regeneration are reported separately.
- This is for grafting a bone defect around an existing implant.

D6104, Bone Graft at Time of Implant Placement
- CDT descriptor: "Placement of a barrier membrane, or biologic materials to aid in osseous regeneration are reported separately."
- Placement of a barrier membrane, or biologic materials to aid in osseous regeneration are reported separately.
- This is for bone grafting around an implant at the same time the implant is placed.

D7950, Osseous, Osteoperiosteal, or Cartilage Graft of the Mandible or Maxilla - Autogenous or Nonautogenous, By Report.
- CDT descriptor: "This procedure is for ridge augmentation or reconstruction to increase height, width and/or volume of residual alveolar ridge. It includes obtaining graft material. Placement of a barrier membrane, if used, should be reported separately."
- This is not a graft done in an extraction site or implant removal site.

D7953, Bone Replacement Graft for Ridge Preservation
- CDT descriptor: "Graft is placed in an extraction or implant removal site at the time of the extraction or removal to preserve ridge integrity (e.g., clinically indicated in preparation for implant reconstruction or where alveolar contour is critical to planned prosthetic reconstruction). Does not include obtaining graft material. Membrane, if used should be reported separately."
- This is for a graft to fill in the hole where the tooth or implant was just removed.

D7951, Sinus Augmentation With Bone or Bone Substitutes Via a Lateral Open Approach.
- CDT descriptor: "The augmentation of the sinus cavity to increase alveolar height for reconstruction of edentulous portions of the maxilla. This procedure is performed via a lateral open approach. This includes obtaining the bone or bone substitutes. Placement of a barrier membrane if used should be reported separately."
- This is also referred to as a sinus lift.
D7952, Sinus Augmentation Via a Vertical Approach
- CDT descriptor: "The augmentation of the sinus to increase alveolar height by vertical access through the ridge crest by raising the floor of the sinus and grafting as necessary. This includes obtaining the bone or bone substitutes."
- This is also referred to as a sinus lift.

D3432, Guided Tissue Regeneration - resorbable barrier, per site, in conjunction with periradicular surgery.
D4266, Guided Tissue Regeneration - Resorbable Barrier, Per Site
- CDT descriptor: "This procedure does not include flap entry and closure, or, when indicated, wound debridement, osseous contouring, bone replacement grafts, and placement of biologic materials to aid in osseous regeneration. This procedure can be used for periodontal and peri-implant defects."
D4267, Guided Tissue Regeneration - Non-Resorbable Barrier, Per Site
- CDT descriptor: "This procedure does not include flap entry and closure, or, when indicated, wound debridement, osseous contouring, bone replacement grafts, and placement of biologic materials to aid in osseous regeneration. This procedure can be used for periodontal and peri-implant defects."
- Includes membrane removal.

D3431, Biologic Materials To Aid in Soft and Osseous Tissue Regeneration in conjunction with periradicular surgery.
D4265, Biologic Materials To Aid in Soft and Osseous Tissue Regeneration
- CDT descriptor: "Biologic materials may be used alone or with other regenerative substrates such as bone and barrier membranes, depending upon their formulation and the presentation of the periodontal defect. This procedure does not include surgical entry and closure, wound debridement, osseous contouring, or the placement of graft materials and/or barrier membranes. Other separate procedures may be required concurrent to D4265 and should be reported using their own unique codes."

*Current as of CDT 2017