Below is a document provided by the Ontario Dental Association that addresses commonly asked questions on dental implants and bone grafting.
Grafting Codes and Implant Placement April 25 2015
Tissue grafting has been utilized by dentists to correct mucogingival and osseous defects around natural dentition prior to the implementation of dental implants into mainstream dental practice. As dental implants have gained more acceptance, similar procedures are done to augment the hard and soft tissue support around dental implants.
Grafting procedures from the Periodontal chapter and/or the Surgical chapter are used, depending upon the dentist’s certification.
Periodontists use the grafting codes from the Periodontal chapter of the ODA Suggested Fee Guide for Certified Periodontists whether the intent is to correct a periodontal defect about a natural tooth or to augment support tissue about a dental implant.
Oral & Maxillofacial Surgeons (OMF) use the grafting codes in the Periodontal and Surgical chapters of the ODA Suggested Fee Guide for Certified Oral & Maxillofacial Surgeons depending upon the intent of treatment and the service(s) performed.
General Practitioners use the grafting codes from the Periodontal and Surgical chapters of The ODA Suggested Fee Guide for General Practitioners depending on the intent of treatment and the service(s) performed.
There are different scenarios involving graft material that present when placing implants. These include, but are not exclusive to:
- Immediate extraction with the placement of graft material at the socket/implant gap;
- Placement of material where a surgical or anatomical dehiscence has occurred and graftmaterial and/or a membrane is used to protect the covering of the implant;
- Use of graft material to perform an internal sinus graft with immediate placement of implant;
- Use of graft material, membranes, tacks, possibly PRP to perform a formal sinus liftprocedure with the immediate placement of implants;
- The use of implants and graft materials such as membranes, mesh, tacks/screws toreconstruct a ridge where there is absolutely inadequate amount of bone
1) Immediate extraction with the placement of graft material at the socket/implant gap:
Where implants are placed at the same appointment as the extraction and graft material, coding is handled as a routine implant placement. The codes to use will depend upon the implant placed. The use of bio-osseous or mineral osseous material is considered part of the expense of the implant placement and there would be no additional code used to report the placement of the osseous material. The expense of the osseous graft material is added to the expense of the implant hardware costs and the procedure code used to report all additional expenses is 99555.
2) Placement of a material where a surgical or anatomical dehiscence has occurred and graft material &/or a membrane is used to protect the covering of the implant;
Depending on the extent of the problem this situation can be considered either as ridgeretention,orguidedtissueregeneration(GTR). Wheretheintentistocorrect a surgical or anatomical dehiscence (ie: periodontal defect) procedure codes 42611 or 42621 would be used.
Grafts, Osseous, Autograft (including flap entry, closure and donor site)
42611 Per Site
Grafts, Osseous, Allograft (including flap entry and closure)
42621 Per Site + E
If GTR is performed in addition to the osseous grafting procedure, codes 42701- 42703 are used.
Guided Tissue Regeneration
42701 Guided Tissue Regeneration – Non-resorbable Membrane, per site + E
42702 Guided Tissue Regeneration – Resorbable Membrane, per site +E
42703 Guided Tissue Regeneration – Non-resorbable Membrane, Surgical Re-entry for Removal
* Note: If the intent of treatment is simple ridge preservation of the alveolar bone, General Practitioners and Oral Surgeons use codes 72411 – 72439. If a membrane is also placed, the cost of the membrane would be added to the additional expense of grafting material costs.
Alveolar Bone Preservation – Autograft
72411 First tooth
72419 Each additional tooth
Alveolar Bone Preservation – Allograft
72421 First tooth +E
72429 Each additional tooth +E
Alveolar Bone Preservation – Xenograft
72431 First tooth +E
72439 Each additional tooth +E
We are sometimes asked if procedure code 42721 described in the Fee Guide as Biologic Materials to aid in soft and osseous tissue regeneration (not including surgical entry and closure) could be used for socket grafting. This procedure is intended to describe the use of products that are neither bone grafts nor do they require the use of a membrane. There are a number of such materials, enamel matrix derivative (EMD) and a collagen sponge with and without bone stimulating proteins. These materials are used in the treatment of periodontal disease and they are performed in conjunction with another periodontal surgical procedure from the 40000 code series.
Procedure code 42721 does not include the surgical entry or the closure; those components are part of the periodontal surgical procedure performed. These biologic materials are used to help facilitate the formation of the periodontal attachment apparatus, including bone, cementum, and fibers of the periodontal ligament to improve the attachment levels and enhance the restoration of the supporting structures lost through periodontal disease processes. It would not be appropriate to use code 42721 if the service performed is post extraction socket preservation.
3) Use of graft material to perform an internal sinus graft with immediate placement of implant
Defined in the Fee Guide as an internal sinus lift, procedure codes 79354 – 79356 would be used.
79354 Sinus Osseous Augmentation, Indirect Inferior – Autograft +E 79355 Sinus Osseous Augmentation, Indirect Inferior – Allograft + E 79356 Sinus Osseous Augmentation, Indirect Inferior – Xenograft + E
4) Use of graft material, membranes, tacks, possibly PRP to perform a formal sinus lift procedure with the immediate placement of implants
Defined in the Fee Guide as a formal sinus graft, procedure codes 79351 – 79353 would be used.
79351 Sinus Osseous Augmentation, Open Lateral Approach – Autograft +E 79352 Sinus Osseous Augmentation, Open Lateral Approach – Allograft + E
79353 Sinus Osseous Augmentation, Open Lateral Approach – Xenograft + E
5) The use of implants and graft materials such as membranes, mesh, tacks/screws to reconstruct a ridge where there is absolutely inadequate amount of bone.
Defined in the Fee Guide as a formal alveolar graft, procedure codes 73511-73521 would be used.
Reconstruction, Alveolar Ridge, with Autogenous Bone
73511 Per sextant + E
Reconstruction, Alveolar Ridge, with Alloplastic Material
73521 Per sextant + E
* Reconstruction of the alveolar ridge is also performed where there is not enough bone to retain a removable denture (where no implants will be placed).
A complete list of all important Canadian dental implant codes is also listed on our mobile app “Dental Code Lookup” under the “Implant” tab.