5.21.10 Issue #428 Forward This Newsletter To A Colleague

Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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Prophylaxis Based or Periodontal Therapy Based Practice?

Are you curious if your office is producing at industry standard when it comes to interceptive periodontal therapy treatment? If you did 10 periodontal maintenances and no root planing last month, this is good if you only saw a total of 30 patients for the month. However, if you are seeing more patients a month and that is all that the hygiene department produced when it comes to an interceptive periodontal therapy, then the numbers you should have are not there.

33% of total hygiene production should come from ancillary services, including interceptive periodontal therapy. Running a report from your computer to see exactly how many periodontal maintenances were done in your office last month will allow you to see where you stand.

You may find that your hygiene department is doing almost all prophylaxis coded 3-month recalls, even though many of the patients have a history of root planing. This is very common because previously, the periodontal maintenance code (4910) was not being paid by insurance companies, and as a result, many offices were overusing the prophylaxis code (1110). Now, some insurance companies will actually pay for four periodontal maintenances and only two prophylaxes a year. This depends on the insurance limitations and benefits the patient’s employers are willing to pay for. 

All of your existing patients should really be on a periodontal maintenance recall and need to be coded correctly. If you were to start changing the code on your existing patients, that have been through root planing in the past, to the periodontal maintenance code and charging more for their treatment, then you may have a lot of very upset patients. 

These are the patients that you need to really evaluate and possibly have them in for scaling and root planing. If they are healthy prophylaxis and 3-month recall is working for them, then keep them as a 3-month prophylaxis. If there is heavy bleeding during instrumentation or bleeding upon probing, then look at where you would want to do root planing and see if the pockets are there. Remember that 2 and 3 millimeter pockets are considered within normal limits. It is not just the pocket depth, but also the clinical attachment loss that may make the difference. So, not only should 6 probing pocket depths be recorded at every recall, but so should recession. Also, keep in mind that healthy gums don’t bleed.

Most insurance companies are going to want two quadrants of root planing before they will pay for the periodontal maintenance code, however there are some that do not require this. When it comes to insurance, there is no way we can know what the benefits and limitations are for the thousands of plans out there.

Those patients that receive only one quadrant of 1-3 teeth (4342) or one quadrant of 4 or more teeth (4341) are maintained based on what the individual patient needs when they return for their first recall appointment. You may want the first recall scheduled at a 3-month interval. You may find that when you chart the patient’s probings and recession, they are now actually a prophylaxis and not a periodontal maintenance patient. This is another time when the clinician needs to really evaluate the health of the patient, to determine what is the best recall and the correct code to be used based on the patient in their chair at the time. You may find that most patients that have 1-3 in only one quadrant will be a prophylaxis. If the patient does present the need for a periodontal maintenance appointment, make sure you inform them that it may only be covered at a lesser fee of a prophylaxis. If you go ahead and do it without letting the patient know that it may not be covered, you can end up with an upset patient on your hands!

You may also want to make sure that the patient is not only verbally aware of the difference between a prophylaxis, but also perceives what is done differently at a periodontal maintenance appointment compared to a prophylaxis. Keeping your patients informed of their benefits to the best of your knowledge will help to reduce loss of patients in the future. This does not mean that treatment is based on insurance limitations. This means that informing the patient as much as possible is a good practice.

As you start to evaluate your patients and their needs to help them improve their periodontal health, you may find that your production numbers go up, and more importantly you may see the gingival health of your patients improving.

Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

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