Question and Answer
“I am a hygienist trying to develop a periodontal program in my office. If an existing patient comes in for a hygiene appointment, and the periodontal probings are 2-3 millimeters throughout the entire mouth except for the lower right quadrant (which has 3 areas of 5 millimeter pocketing and bleeding upon probing), how do you treat this? Should the infection be treated first followed by bringing the patient back for a prophylaxis? How would this be coded?”
There is no black and white answer to this question. The optimal treatment would be to work on the lower right quadrant (billed out as root planing 1-3 teeth) then have the patient return for the prophylaxis. However, don’t forget to consider what the patient is expecting at the appointment. If you or the doctor suspect the patient will be upset if they do not get their regularly scheduled hygiene appointment, and if you risk losing the patient, then it may be better to go ahead with today’s appointment and have the patient back in to have the root planing done.
Knowing the patient’s personality type and having a strong, trusting relationship with him or her is important. Learning how to read people’s non-verbal communication as you are presenting treatment and educating them about the treatment needed can be priceless. Will delaying treatment for one day or even two weeks really make a big difference? If the hygienist is going to go ahead with treatment, make sure the financial coordinator has time to go over the financials before the patient decides to move forward. If this is not done and the cost is more than the patient anticipated, then again, the office may lose a patient.
If the patient has insurance that you are looking to maximize, we get into another story all together. It is important for your financial coordinator to know the best way to present the treatment. Some insurances will not pay for a prophylaxis after the root planing is done for up to anywhere from 45 to 90 days. Some insurances are perfectly fine with a prophylaxis being done right after a quadrant of root planing, but will not pay for a periodontal maintenance appointment for up to 90 days after root planing. Insurance may not pay for the periodontal maintenance appointment at all if two or more quadrants are not done. And then some insurances will allow not only the prophylaxis, but also root planing on the 1-3 teeth on the same day!
Unfortunately, many of our patients are concerned about cost in addition to wanting to keep their teeth. So, you may end up being better off doing the hygiene appointment today as scheduled and educating the patient about the need for the root planing at a future appointment. Have the patient return for the quadrant of root planing as soon as possible. This will allow the patient to maximize insurance coverage while keeping your hygiene appointment time from being cut into because of the financial coordinator going over finances before you get started.
Here are some questions to ask yourself when deciding between doing the cleaning the patient is expecting or moving forward with root planing. Is it better to go ahead immediately with the quadrant of root planing if you are also cutting into the time needed to perform quality of care? Is it worth possibly losing a good long-term patient of record because you started the root planing that day?
It would be nice if the answers to all of our questions were black or white - it would make our jobs much easier. Regardless of insurance, patients need to be informed of their needs in order to have a healthier oral cavity. It is our responsibility to educate them as much as possible, not only on why they need to have treatment done for their health, but the many options that are available to help them pay for it. CareCredit is always an option to help defer cost, even if they have insurance. The patient needs to be enabled to make an educated decision on their own.
Interested in improving your hygiene department? Email firstname.lastname@example.org and ask us about our 1-Day Hygiene Training Program or call 877-777-6151
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