Hygiene Question and Answer
I was recently asked the following question:
When a new patient comes in and we diagnose them with periodontal disease and treatment plan them for scaling and root planing, we offer them a prophylaxis at that visit to get the supra gingival calculus off the teeth and get them feeling better. We then have them come back for scaling and root planing, and they are aware prior to the prophylaxis that they will still need to return for the scaling and root planing. This has helped alleviate those patients who complain about not getting their teeth cleaned the day they come in. We have had no issues with insurance regarding coding a prophylaxis prior to scaling and root planing.
Full mouth debridement reimbursement is about double a prophylaxis, so it would be beneficial financially. It would require us to change how we do a few things as well. What are your thoughts on this and what do you see in practices?
When it comes to only removing the supra gingival calculus, this does not fit the code for a D1110. The code for a prophylaxis includes subgingival scaling. With that said, it is recommended that you provide the patient with the cleaning appointment they came in for to help alleviate the possibility of them complaining or possibly not returning to your practice. However, this appointment should include subgingival cleaning also.
It is great that the patient is aware of the need for scaling and root planing before the prophylaxis appointment, and I hope financials are also reviewed with the patient at that time. If the patient is motivated and wants to move forward with the root planing immediately, perhaps they will proceed with the root planing that day. During this time, the hygienist will continue to educate the patient about their periodontal disease and the treatment that has been recommended.
When it comes to having a prophylaxis before scaling and root planing, at this time most insurances are alright with this – but as we all know, this could change at any time. Some offices will do a prophylaxis after the scaling and root planing to clean the areas that are healthy. Many insurance companies do have a problem with this, but the patient is told during the financial consult that they are responsible for this “fine scale” appointment cost, and the patient is seen as a periodontal maintenance three months later.
You are correct when it comes to the description and use of the code for a full mouth debridement. The code is to be used to facilitate diagnosis. It has been my experience that this code is one of the most misused codes there is. I have not heard that you cannot do an exam on the same day.
The problem with the full mouth debridement code is that many insurances do not even cover it, or they cover it only once in a lifetime. So, if you inform a patient that it should be covered and then it is not covered, you may end up losing the patient.
More than anything, it is not using the code correctly – and that is fraud. Yes, full mouth debridement is about double the dollar amount financially and would be more beneficial to the practice. However, misusing a code is still fraud, and it is not recommended. The way your practice is currently doing their periodontal therapy is the most ethical and will help patient retention.
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