Is It Root Planing or Full Mouth Debridement?
There are offices that are probing new patients and continuing to follow the old way of thinking that only 5 mm or above need to be root planed. These offices use the code for full mouth debridement, have the patient return for a prophylaxis in 2 weeks, and then come back in 3 months for their continuing care. The problem with this is that the patients being billed out as full mouth debridement probably need to be treatment planned for root planing, whether it is one to four quadrants, 1-3 teeth or 4 or more teeth. They are not entering the correct insurance code with the treatment needed.
The code for a full mouth debridement is very specific in its use and I may see only two patients in an entire year that require this code. Misusing the full mouth debridement code is not doing a favor to your patients, hygienist, or practice production. Using this code is usually under-treating a periodontallyinvolved patient, and makes the hygienist work twice as hard at half the cost that it should be done. It usually costs the patient more out of pocket money also, as many insurance companies will not even cover the full mouth debridement code, and even if they do it may only be covered once in the patient’s lifetime or may only cover a portion of the amount. Then there are the insurance companies that will cover it as a prophylaxis and when the patient returns for their 2nd appointment in order to complete the treatment, the insurance will consider this the second prophylaxis in a year and now the patient is out of benefits when it comes to future hygiene appointments.
Once a full mouth debridement is completed, it does not constitute future appointments being considered periodontal maintenance appointments. If this is done, the hygienist will once again find herself working twice as hard at half the cost at the patient’s future recall appointments. Also, the patient will more than likely have to pay for the entire appointment out of pocket because the allowable benefits for a prophylaxis were utilized. If the patient was not informed of all of these out of pocket expenses in advance, they are going to be upset with your office and could end up going to another practice. It’s never a good thing to have more patients leaving out the back door than you have coming in new through the front door! Unfortunately, this happens all too often and is not even noticed until the office is struggling.
Whenever you are considering treatment planning full mouth debridement, slow down and take a really good look at the 6-point probings, x-rays, bleeding upon probing, and amount of calculus to be removed. If the patient has even one or two 4 mm pockets in a quadrant, a lot of inflammation, and has not been seen on a regular basis, this may be a patient that should be root planed. There is nothing saying that every patient has to have four quadrants of root planing. Treatment planning the root planing will allow for better quality of care.
Many insurance companies require that a patient have at least two quadrants of root planing in order to return in 3 months as a periodontal maintenance appointment. It does not matter if they have two quadrants of 1-3 teeth or two quadrants of 4 or more teeth. There is a specific code for root planing 1-3 teeth, and it is recommended that your office have a specific fee for the code. Just like root planing 4 or more teeth, the fee is not decreased because you are only root planing 4 teeth rather than 6 or 8 teeth. The code is specific to how many teeth need root planing per quadrant, not half mouth.
Of course, insurance benefits and the patient’s employer decide what plan they choose to pay for and the limitations the plan has for the individual. Whenever your insurance person becomes aware of such limitations they may want to educate the entire office at a staff meeting about them. This is so insurance benefits may be maximized by your office for the patient. This is not to determine treatment needed - that is done by the clinician in the chair and the individual patients overall health and oral health presented at the time of services.
Treatment planning patients for root planing instead of full mouth debridement will usually provide better insurance coverage, less out of pocket expenses for the patient, and more time for the hygienist to provide quality care for the patient. In return, the office may increase production, patient retention, and reduce the stress level. Utilizing the correct insurance code, appropriate time and treatment needed when treatment planning your patient will benefit everybody.
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