D4245Apically Positioned Flap

What This Code Covers

D4245 covers apically positioned flap. The gingival tissue is reflected to gain surgical access to the root surfaces and underlying bone. This allows thorough debridement and may include osseous recontouring.

Billing Guide

Bill this code when:

• The flap procedure described by D4245 is performed
• Periodontal charting and radiographs support the surgical indication
• The number of teeth per quadrant matches the code description

Do not bill this code when:

• The teeth count per quadrant does not match. Verify D4240 vs. D4241
• The procedure is better described as gingivectomy or crown lengthening
• No periodontal diagnosis supports the need for surgical intervention
• The procedure is better described by D4230 (Anatomical crown exposure - four or more contiguou...)

Insurance and Denial Prevention

Key Payer Rules:

• Periodontal treatment is typically covered as a major service (50-80%)
• Full-mouth debridement (D4355) and D4346 may have specific frequency limits
• Surgical periodontal procedures often require documentation of previous non-surgical treatment
• Some plans require periodontal charting with probing depths for approval

Common Denials and How to Respond:

• Insufficient documentation - Submit complete periodontal charting, radiographs, and a narrative of findings.
• Non-surgical treatment not attempted first - Document previous scaling/root planing and explain why surgery is now indicated.
• Frequency exceeded - Verify the payer's frequency schedule for the specific procedure.