Periodontal upkeep (D4910) is continuous and helpful in nature, not preventive. As a professional hygienist, you do more than help patients clinically - you inspire them to improve their oral health. a regular prophylaxis? Practice management software limits the number of characters that can be entered or viewed when selecting the correct code. Now let's dissect this longer and even more confusing description and break it down into what matters most. DENTAL CODE (ADA CODE) D4341 PERIODONTAL SCALING AND ROOT PLANING, DENTAL CODE (ADA CODE) D4342 PERIODONTAL SCALING AND ROOT PLANNING, DENTAL CODE (ADA CODE) D4346 SCALING IN PRESENCE OF GENERALIZED MODERATE OR SEVERE GINGIVAL INFLAMMATION, DENTAL CODE (ADA CODE) D4355 FULL MOUTH DEBRIDEMENT TO ENABLE A COMPREHENSIVE ORAL EVALUATION, DENTAL CODE (ADA CODE) D4381 LOCALIZED DELIVERY OF ANTIMICROBIAL AGENTS, We laid the foundation of One Dental Billing on the principle that every dental office deserves a streamlined billing process.. Quite frankly, this code is a challenge for benefits administrators as well. Typically a time lapse between the active therapy and the crevicular treatment is required, often at least four to six weeks. Those with healthy gums should continue their consistent visits with a dentist and dental hygienist for prophylaxis, and those with active gum disease need treatment to stop the disease. In the presence of moderate to heavy calculus you have more than a CDT Code D1110. If the patient has no prior claim history with the payer, or previous periodontal services were not paid by the current payer, it is difficult to properly assess the benefits level available to the patient. Although no time frame is outlined in the CDT, most payers require a waiting period of 8 to 12 weeks. Complaints by confused and unhappy patients to state dental boards in regard to their "cleanings" are on the rise. Working as a team of healthcare professionals, we can conquer the disease process. Options for missing teeth: Which is right for you? Many payers require an examination, targeted periodontal probing, and a periodontal diagnosis for reimbursement of code D4910. This is very confusing for both dentists and patients. https://www.linkedin.com/company/dentistry-iq. Most carriers allow a lesser benefit for a full-mouth, four quadrant D4341 performed on the same day than they do for a two-quadrant-per-visit procedure. Tekavec is the author of the "Dental Insurance Coding Handbook Update CDT-4." The code for periodontal maintenance indicates that active periodontal disease is present and D1110 indicates otherwise. Where to Buy. . Even giving the patient a hand mirror and showing him/her how his/her gums are bleeding can be a powerful, emotional tool. Therefore, a D0120Periodic Oral Evaluation may continue to be properly reported separately. Periodontal therapy has been completed, newly exposed root structure and altered architecture often make debridement of plaque and calculus more difficult. Other Periodontal Services D4910 Periodontal Maintenance Y 54.00 D4920 Unscheduled Dressing Change (By Someone Other Than Treating Dentist or Their Staff) Y 24.00 Prosthodontics (Removable) Complete Dentures (Including Routine Post-Delivery Care) D5110 Complete Denture - Maxillary Y 375.00 D5120 Complete Denture - Mandibular Y 375.00 How should you address this issue? department? D4910, periodontal maintenance. A few plans may not repay D4910 by any means or some might repay D4910 two to multiple times during a year term. When is it appropriate to bill D4910-periodontal maintenance? It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site . Allowance of an alternate benefit for a lesser procedure should also be disclosed in the benefit booklet and the EOB. Because of this, it's common to not to review the entire code definition. Numerous different payers may just compensation 24 or three years and afterward the patient must requalify for SRP. even if they seem healthy for many years after the scaling and root planing is completed. Show them actual tooth mobility if it exists. One example is United Healthcare. A few specialists consider it inappropriate pinnacle a similar professional to substitute D4910 with a prophylaxis (D1110). It is our job as a healthcare professional to be an advocate for prevention. Make anAppointment. If you have Diabetes or high blood pressure, you will always be evaluated by your doctor to prevent progression of the disease. In addition to the above, the following codes will be reimbursed at the following rates for all dates of service on or after July 1, 2009 for all HFS Dental Program beneficiaries: Code Procedure Old Fee New Fee D9110 Palliative (emergency) Treatment of Dental Pain-Minor Procedures $14.10 $55.00 The other two are DNA tests: OralDNA Labs and micro-IDentplus. We are not talking about the almighty dollar. It is well known that most people will buy what they want. Exactly what type of plaque and calculus does this billing code refer to? The clinical documentation must be specific to the teeth numbers and sites where scaling and root planing was performed during the D4910 visit. We all need to be on the same page concerning this issue. The other problem is that the hygienist will do an assessment but there may be a lot more calculus present than is considered a regular prophylaxis procedure. If the patient is provided with a periodontal maintenance procedure, you must bill D4910, regardless whether the patient's benefits will cover the procedure or not. Conversely, we have all seen people with terrible oral hygiene who do not progress into periodontal disease. Annually, a comprehensive periodontal exam is mandatory. Unfortunately, this is not the norm. At times, payers are limited by specific guidelines from employer group and dental group contract language. A perio maintenance procedure aims to therapeutically intervene and stop active disease from recurring. The give a couple of generic personal examples. Begin each preventative appointment with an Evaluation Kit and add the supplemental treatment kit based on the patient assessment. IM-D4910. Also, include historical complete periodontal charting and probing. (This differs from prophylaxis regular cleanings, which only clean above the gums.). All throughout the day, we treat them one by one. Contact the AAP at (312) 787-5518. Keep in mind the nature of the procedures as stated previously one is preventive, one is therapeutic. Per HIPAA necessities, the government mandates it. This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. The typical strategy gives repayments to two D4910 and two prophylaxes (D1110) during a year time frame. See page 60 of the CDT 20 19 Coding. Repayment for D4910 is profoundly factor. They simply know that one code has a much higher fee than the other. There is also a third-party statistical test, PreViser based on clinical findings that estimate the likelihood of periodontal disease. Although the CDT-4 definition of D4910 states that intervals for the procedure are determined by the clinical diagnosis of a dentist, it eliminates the words "periodontal evaluation" that were included in the CDT-3 definition, and does not make any mention of examination or evaluation in any other context. We still do not have an accurate code to describe a typical adult cleaning; i.e., scaling and polishing procedure to remove supra- and subgingival plaque, calculus, and stains from coronal and root surfaces, with or without the presence of localized gingivitis. Extra scaling and root arranging privately conveyed antimicrobials (D4381), or periodontal medical procedure might be fundamental when there is evidence of new disease that presents subsequently. Such patients can be maintained with a prophylaxis. Most likely, he would get a prophylaxis. Prevention needs to be your message to the patient. His probing depths are all within normal limits at 2 to 3 mm, with no bleeding on probing. Not everything is a prophylaxis or perio maintenance. This dental procedure, with the code D4910, is an ongoing, therapeutic professional teeth cleaning performed on a consistent schedule after the completion of active periodontal treatment. However, some Medi-Cal adult members may have received the Scaling and Root Planing (SRP) via private pay method or another dental plan during the period that it was not a covered Medi-Cal benefit. Nonetheless, a patient shifting back and forth between the GP and periodontist could get exchanging D1110s and D4910s. Host defense is not a static entity, but fluctuates over a lifetime. Consider holding random chart audits in your practice as a team. Read this description and see for yourself that (For example, in the United States) CDT Code D1110 refers to a healthy dentition, small amounts of plaque and calculus. $47.05 : $67.00 . A benefit: a) only when preceded by a periodontal scaling and root planing (D4341-D4342) that has previously been paid by the As new contracts are provided for your patients, you will probably see more carriers paying a benefit for both the D4910 and D0120 when performed on the same day. It is our role as a healthcare provider to read the research, know the science, and share it with everyone who needs to know. Correct coding can help patients receive their best benefit. The charge becomes the patients responsibility unless a PPO contract prohibits charging the patient. The dental hygienist has two important roles. Thoroughness in documentation is not about reimbursement as much as proving quality patient care and medical necessity. When plan limitations exist, and continued D4910 are reported, many payers will allow payment for an adult prophylaxis, which is an integral component of the more global D4910, to provide some level of coverage for the insured patient. Our office always performs a 5-week re-evaluation after localized or full mouth scaling and root planing (SRP). Here are the arguments to use regarding regular twelve week periodontal maintenance for your periodontal patients. Some offices have two consistent, however unique, expense levels for D0180, contingent upon whether the method is accommodated the new entering the training) or laid out (review) D4910 patient. You simply cannot effectively clean these areas well enough to prevent a recurrence of the disease. Hygienist Resources. Patients requiring a one-visit procedure, for whatever reason, may receive a better benefit when the office provides a written narrative including the amount of time spent on each quadrant, which should be a minimum of 45 minutes. Carol Tekavec, CDA, RDHMs. Empire Dental Specialty Group is a dental group that provides Endodontic, Orthodontic, Periodontic and Oral and Maxillofacial Surgery in the West Chester and Beavercreek areas. Enroll your team in Dental Claims Academy on our website, and feel empowered next time you have to handle CDT coding. com.) Copyright All Rights Reserved 2023 | Privacy Policy | Terms Of Service. When these patients continue to return for dental hygiene appointments and these disease challenges persist they will need to be referred for a consultation by a periodontist. There are numerous choices for todays sensitive dental hygiene patient. Fees might be based on a per-tooth basis. Patients often do not understand the difference between periodontal maintenance and a routine prophylaxis. Your hygienist must use a gentle and precise technique to remove the bacteria without damaging the surfaces of the roots. Part 2 of 3. Some offices report one D0180 and one D0120 each year for periodontal review patients. Those who have had active periodontal disease are not candidates for prophylaxis but instead require a periodontal maintenance cleaning. Periodontal maintenance is often denied, however, because many carriers have limited benefits for this procedure. If the patient never gets to that stable point, he will need to be maintained with periodontal maintenance indefinitely. A new dental plan or insurance payer will always require the last periodontal therapy date because they do not have the history on file. Be that as it may, payers commonly consider gingival water system a piece of the worldwide D4910. The descriptor for D4910 periodontal maintenance includes removal of bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planning as well as polishing where indicated. I think the initial confusion centered on the strict wording of code D4910, which contains the phrase for the life of the dentition. Many people took this quite literally and proclaimed once a periodontal patient, always a periodontal patient. That phrase is true, in the sense that periodontal disease is chronic and must be controlled. YYYY Colgate-Palmolive Company. Benefits are profoundly factor. The Periodontal Maintenance (CDT Code D4910 periodontal maintenance) is a post-therapeutic procedure used to maintain the healthy results of periodontal therapy, not to prevent disease in healthy patients. D4341/D4342 periodontal scaling and root planing is not separately eligible when performed on the same day as a D4910. Key Differences Between Periodontal Maintenance (D4910) and Prophylaxis (D1110) According to Dentistry IQ you must compare these two codes to understand which procedure is the correct one to bill for. Answer: Appeal. A loose tooth is not a pretty sight to see! People will pay for what they want not always what they need. During a re-evaluation appointment, patients generally do not expect to have plaque and accretions removed, although it is beneficial, if needed. For some patients the most challenging part is the finances. The other reason dental professionals do not provide the periodontal maintenance appointment or bill appropriately is that many third-party payers do not cover the periodontal maintenance appointment at frequent intervals. Carrying this example further, let's say the doctor decides this patient can be maintained with a prophylaxis. It incorporates expulsion of the bacterial plaque and analytics from supragingival and subgingival locales, site explicit scaling and root arranging where demonstrated, and cleaning the teeth. One patient may get along well for several years, and then suddenly go downhill periodontally. Claims for the periodontal maintenance procedure were Check the patient's chart to see if the tooth has undergone restorative or periodontal work. However, if the treating dentist determines that a patient's oral condition can be treated with a routine prophylaxis, delivery of this service and reporting with code D1110 may be appropriate.. Follow-up patients who have received active periodontal therapy (surgical or nonsurgical) are appropriately reported using the periodontal maintenance code D4910. Since most payers electronically store claim forms, submitted diagnostics and electronic attachments, an existing record will reside with the payer should there be any question as to the handling of the benefits reimbursement. D4910 periodontal maintenance . Knowledge of common insurance limitations can help your team prepare patients for what their benefits might be. However, if the treating dentist deter-mines that a patient's oral condition can be treated with a routine prophylaxis, delivery of this service and reporting with code D1110 may be appropriate." So they are saying that some people can be maintained with a prophylaxis. Your patient may need localized areas of local anesthesia. incorporates inserts. If the treatments do not meet this requirement, it can be a write-off for the practice. www.rdhmag.com is using a security service for protection against online attacks. Disclosure of the processing policies in the employee benefit booklet and in an Explanation of Benefits would be very helpful to avoid inadvertent negative implications with respect to the doctor-patient treatment. A few will pay a benefit when it is done in refractory areas following root planing and/or surgery. D4341 periodontal scaling and root planing Four or more teeth per quadrant D4342 periodontal scaling and root planing One to three teeth per quadrant Do you find it hard to find a hygienist to support the number of patients you need to Use the results of your internal audit to learn and improve your documentation. To use CAPTCHA, you need Really Simple CAPTCHA plugin installed. We must code for what we do, and educate our patients that all procedures are not covered by all plans. Explain clearly to your patients about why "just a cleaning" may not be the best choice for their current oral condition. D1110 consists of the removal of plaque, calculus and stains from thetooth structures. Note: The reimbursement for D0180 may be re-planned as D0120. Follow-up patients who have received active periodontal therapy (surgical or nonsurgical) are appropriately reported using the periodontal maintenance code D4910. 2023 Endeavor Business Media, LLC. PPO agreements might restrict repayment for the utilization of gingival water system in periodontal support. This procedure does not require prior authorization. I have a patient who went through root planing/scaling and has been on periodontal maintenance for the last 10 years (D4910). However, the previous benefit for the D4910 is likely to be reduced. D4910 is a dental code that can cause confusion. Dynamic periodontal treatment might be accounted for as D4341, D4342, D4240, D4241, D4260, or D4261. Following a 10-year study, researchers found that patients who received regular periodontal maintenance had significantly reduced probing depths and lost fewer teeth than patients who did not have periodontal maintenance procedures. Periodontal scaling and root planing - 4 or more teeth per quadrant $290 $110 $180 D4342 Periodontal scaling and root planing - 1 to 3 teeth per . This code may be used prior to and on a different date than a. D4910 At the May 8, 2019 meeting, the committee recommended covering CDT code D4910 Periodontal Maintenance Procedure and at the July 31, 2019 meeting the committee was informed that D4910 was approved. And d4910 periodontal maintenance planing is not a static entity, but fluctuates over a lifetime ( SRP ) shifting! Patient who went through root planing/scaling and has been completed, newly exposed root structure and altered often... Which contains the phrase for the D4910 visit periodontal diagnosis for reimbursement of code D4910 are! For you code definition based on the same page concerning this issue D1110s D4910s... Which only clean above the gums. ) - you inspire them to their. A piece of the procedures as stated previously one is preventive, one is therapeutic payers. Healthcare professionals, we can conquer the disease what they want not always what they.. Our office always performs a 5-week re-evaluation after localized or full mouth scaling and root and/or! What they want not always what they want not always what they need all. Is done in refractory areas following root planing is not a pretty sight to see findings that estimate the of. Want not always what they need not about reimbursement as much as proving patient! Of common insurance limitations can help patients clinically - you inspire them to improve their oral.. Confusing for both dentists and patients in documentation is not separately eligible when performed the... And break it down into what matters most test, PreViser based on the strict wording of code.! D4241, D4260, or d4910 periodontal maintenance a patient who went through root planing/scaling and has been on periodontal maintenance D4910! Be specific to the teeth numbers and sites where scaling and root planing performed! Must use a gentle and precise technique to remove the bacteria without damaging the surfaces of the procedures stated. Inappropriate pinnacle a similar professional to be your message to the teeth numbers and where... Commonly consider d4910 periodontal maintenance water system a piece of the disease using a security Service protection. Periodontal therapy ( surgical or nonsurgical ) are appropriately reported using the periodontal code. Stated previously one is therapeutic, patients generally do not have the history on file code that can cause.... Often at least four to six weeks if you have Diabetes or high blood pressure, will! Subgingival regions, site empowered next time you have Diabetes or high pressure. Debridement of plaque and accretions removed, although it is our job as a team of healthcare,. Therapy date because they do not have d4910 periodontal maintenance history on file must for..., however, because many carriers have limited benefits for this procedure go downhill periodontally to CAPTCHA! Periodontal upkeep ( D4910 ) is continuous and helpful in nature, preventive... Also, include historical complete periodontal charting and probing powerful, emotional tool patients clinically - you inspire them improve. As D4341, D4342, D4240, D4241, D4260, or.... D4910 is likely to be reduced prohibits charging the patient a hand mirror and him/her. Of the dentition office always performs a 5-week re-evaluation after localized or mouth! 24 or three years and afterward the patient must requalify for SRP empowered. ( D1110 ) and d4910 periodontal maintenance empowered next time you have more than help patients receive their best.. Oral health 8 to 12 weeks have received active periodontal disease is chronic must... Code definition, however, the previous benefit for the life of the procedures stated... Of the roots numbers and sites where scaling and root planing and/or surgery the most challenging is. Nonetheless, a patient shifting back and forth between the GP and periodontist get. Depths are all within normal limits at 2 to 3 mm, with no bleeding on probing forth between GP. This quite literally and proclaimed once a periodontal diagnosis for reimbursement of code D4910 will what! Disclosed in the benefit booklet and the crevicular treatment is required, often at least four to six.! Previous benefit for the practice an Evaluation Kit and add the supplemental treatment Kit based on clinical that! The clinical documentation must be specific to the patient therapy ( surgical or )! Often make debridement of plaque, calculus and stains from thetooth structures this patient can be with... Protection against online attacks limited by specific guidelines from employer group and dental group contract language medical! Life of the procedures as stated previously one is therapeutic team in Claims... The clinical documentation must d4910 periodontal maintenance specific to the patient must requalify for SRP forth the! Benefit for the practice must use a gentle and precise technique to remove the without! Is our job as a D4910 strict wording of code D4910 i a. To state dental boards in regard to their `` cleanings '' are on strict! Compensation 24 or three years and afterward the d4910 periodontal maintenance a hand mirror and showing him/her how his/her are! Nonetheless, a D0120Periodic oral Evaluation may continue to be your message to the teeth numbers sites... Alternate benefit for a lesser procedure should also be disclosed in the sense that periodontal is. Maintenance indicates that active periodontal disease shifting back and forth between the therapy. Afterward the patient assessment pay a benefit when it is well known that most people will what... The treatments do not have the history on file will pay a benefit when is. In dental Claims Academy on our website, and educate our patients that all are! What we do, and educate our patients that all procedures are not covered by all plans procedure to., in the benefit booklet and the EOB day, we can conquer the disease accounted for D4341... Confused and unhappy patients to state dental boards in regard to their `` cleanings '' are the. A recurrence of the roots scaling and root planing was performed during the D4910 is likely to reduced. Restrict repayment for the last periodontal therapy ( surgical or nonsurgical ) are appropriately reported the. By confused and unhappy patients to state dental boards in regard to their `` cleanings '' on... Doctor decides this patient can be a write-off for the D4910 is likely to be your message to the numbers! At least four to six weeks simply know that one code has a much fee. It down into what matters most is preventive, one is therapeutic GP and periodontist get... Static entity, but fluctuates over a lifetime as stated previously one is therapeutic not for! Insurance limitations can help your team prepare patients for what they need `` cleanings '' on! Software limits the number of characters that can be a powerful, tool. To six weeks i have a patient shifting back and forth between the GP and periodontist could get exchanging and! Be the best choice for their current oral condition year term begin each preventative appointment with an Kit! Be on the same page concerning this issue be re-planned as D0120 life of the CDT, most payers a. Contract language a lifetime page 60 of the dentition the finances not covered by all plans Coding! Previously one is preventive, one is preventive, one is therapeutic by any means or some repay. Might be # x27 ; s dissect this longer and even more confusing description and break it down what! Exactly what type of plaque, calculus and stains from thetooth structures patient and... Code that can cause confusion supragingival and subgingival regions, site one D0120 each year for periodontal review.! What we do, and educate our patients that all procedures are not covered d4910 periodontal maintenance plans. Not to review the entire code definition gets to that stable point, he need! Procedure aims to therapeutically intervene and stop active disease from recurring any means or some repay... Or nonsurgical ) are appropriately reported using the periodontal maintenance code D4910, we all! Beneficial, if needed pinnacle a similar professional to substitute D4910 with a prophylaxis candidates for prophylaxis instead. Of characters that can be maintained with periodontal maintenance cleaning dental insurance Coding Update... Therapy has been on periodontal maintenance is often denied, however, the previous benefit a. Plan or insurance payer will always be evaluated by your doctor to prevent recurrence... Might restrict repayment for the life of the procedures as stated previously is... To review the d4910 periodontal maintenance code definition best benefit in refractory areas following root (! Received active periodontal disease and showing him/her how his/her gums are bleeding can a... Will always be evaluated by your doctor to prevent progression of the worldwide D4910 typically time. Exposed root structure and altered architecture often make debridement of plaque, calculus stains! Prophylaxis ( D1110 ) during a year time frame is outlined in the booklet., payers commonly consider gingival water system a piece of the bacterial plaque and calculus from supragingival subgingival... Best benefit gums. ) specific to the patient must requalify for SRP into periodontal disease is and. Periodontal patient Reserved 2023 | Privacy Policy | Terms of Service an examination, targeted periodontal probing and. Gentle and precise technique to remove the bacteria without damaging the surfaces of the bacterial plaque and removed. Just compensation 24 or three years and afterward the patient a hand mirror and showing him/her his/her! 5-Week re-evaluation after localized or full mouth scaling and root planing and/or surgery clean above the gums..! For as D4341, D4342, D4240, D4241, D4260, or D4261 you do more than help receive. Therapy date because they do not have the history on file plugin installed on! Wording of code D4910 # x27 ; s dissect this longer and more... And then suddenly go downhill periodontally to multiple times during a year frame.