Treatment Planning Periodontal Disease
“Tom” the patient has not been in your practice for two years. He is scheduled as a comprehensive exam because it has been so long. When he left your practice, he was being maintained on 3-month periodontal maintenance and the tissue looked good, no bleeding upon probing, and very light if any bleeding during instrumentation.
Tom’s health and dental history are reviewed during his appointment. During this review you find out that he had four quadrants of root planing/periodontal therapy at a different office at the beginning of the year. He used the same insurance that he wants to use for treatment in your office.
Full mouth probings are done, and a full mouth set of x-rays from the other practice are available for your viewing. However, they are not the quality of x-ray your office uses when diagnosing patient needs, so you take a new full mouth of x-rays. In the x-rays, you see visible calculus and radiographic bone loss. When the probings are finished, Tom has generalized bleeding upon probing and some of the pocketing has increased. During the probing you can also feel calculus that is present and will need to be debrided. There are 4 and some 5 mm pockets.
In many offices, a full mouth debridement would be performed and the patient would be asked to return for a second appointment. The problem with this is the code for a full mouth debridement is being utilized incorrectly. Is doing a full mouth debridement really providing the quality of care you would like to provide your patients? Offices choose this approach because they are insurance based and have become accustomed to treatment planning according to insurance benefits. You are well aware that most insurance companies will not pay for the root planing your patient is in need of, due to the benefit being used at the beginning of the year.
If Tom is not scheduled in hygiene that day, then he will return for his quadrants, and it is up to the clinician who treatment planned the quadrants to review why he is in need of this. It is up to the financial person in your office to work with Tom on making the treatment affordable, possibly opening up a CareCredit account as he will be paying out of his own pocket with no help from insurance.
Regardless of what insurance will (or will not) pay, patients have the right to know what is recommended as optimal care. They should also be informed of other options and the results that may be achieved from each. It is not our place to treatment plan according to insurance benefits when the patient needs specific treatment.
Your patients expect you to inform them about what is recommended, regardless of insurance benefits. As long as we inform them of all their options, we have done our job. However, it is the patient’s right to remain sick or diseased based on the information they are given. So when a patient like Tom shows up on your schedule, it is recommended that you treatment plan for what you see, and not what insurance is going to cover.
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