Question and Answer
Question: In our office, we schedule new patients with the doctor for a comprehensive exam and x-rays. Periodontal charting is done, and if we discover areas with pocketing that warrant the need for further treatment, the periodontal chart is given to one of our hygienists to make recommendations. The chart is then given to the front desk to call and schedule the patient for scaling and root planing.
At the next appointment, the patient is scheduled for scaling and root planing with the hygienist, followed by an appointment for the patient to come back for prophylaxis. They are then scheduled for their periodontal maintenance appointment in three, four, or six months.
My question is, can and should we be doing our treatment this way? At the last office I worked in, we saw the patient for their first appointment, then had them back for a prophylaxis or scaling and root planing depending on individual needs. Three to four months later, the patient was back in for their periodontal maintenance appointment if we did scaling and root planing. I am not sure why my current office does the prophylaxis appointment after the scaling and root planing. Is that legal coding? I need to know the proper procedure so I can address this with the other office staff members and we can start the correct procedures accordingly.
Answer: This is accurate coding as long as the work that is being done matches the code. If the work being done does not match the code being used, then it is fraud. It is great that the patient is scheduled with the doctor first for the comprehensive exam and periodontal charting. It is also great to have the patient return for root planing, as long as they are not expecting to have a hygiene appointment that day. If the patient is expecting a hygiene appointment, then something needs to be done – even if just the prophylaxis appointment is completed and root planing is scheduled later. If the prophylaxis is done that day, the hygienist would only concentrate on the healthy areas.
If the prophylaxis is completed, the hygienist would reinforce the need for the patient to return for scaling and root planing by going over the periodontal etiology. Then the patient would return on another day to begin the scaling and root planing. At this scaling and root planing appointment, the hygienist will only be working on the areas that warrant the periodontal therapy.
Many offices do a prophylaxis prior to root planing because the hygienist is seeing the new patient first, and the patient is expecting to have a prophylaxis appointment that day, not just an exam and x-rays (of course, the laws in your state need to be followed). If the patient has been given financials to review and has accepted treatment, and if time permits for the root planing to start at that appointment, you could go ahead and start the root planing that day. However, many offices do a prophylaxis shortly after scaling and root planing is complete. There are a few reasons for this:
1) The patient took so long to get through root planing, they want the entire mouth cleaned at one time. This way when the patient returns for periodontal maintenance after the prophylaxis, all areas are finished at the same time. Many offices call this a fine scale.
2) The hygienist is able to truly concentrate on the periodontally involved areas during the root planing appointments, thus providing more quality time spent in these areas. The prophylaxis provides additional time to work in the healthy areas of the mouth.
3) The prophylaxis is a good opportunity to evaluate how the patient’s mouth is progressing. It is also a chance to provide care to the non-diseased areas of the mouth and fine tune the patient’s home care routine before returning for the periodontal maintenance appointment.
All patients should have their first periodontal maintenance appointment no more than three months after scaling and root planing. Patients should not go any longer between appointments until they have been reevaluated and it is determined by the current health of their mouth that they can space appointments out further and still maintain their periodontal health.
Keep in mind that some insurance plans will not cover the prophylaxis unless it is scheduled a certain number of days after the root planing. Unfortunately, the amount of days is usually longer than what we want, because we still want the periodontal maintenance appointments to begin three months from the prophylaxis. In this case, the patient may end up paying out of their own pocket. It may be best for the Financial Coordinator to include the prophylaxis appointment as part of the patient’s amount that is due, then if it is covered they are happily surprised.
If a patient leaves the comprehensive exam without knowing they have a periodontal condition that needs treatment, then you have a problem. It is recommended that the patient be informed by the doctor, in person. This allows the doctor to support the need and importance of the scaling and root planing appointment, and the perceived value may increase in the patient’s eyes. This also allows the patient to ask a clinician any questions they may have, rather than an administrative person over the phone.
If the patient is told what is needed by the Financial Coordinator and given the estimated cost before leaving, the case acceptance may also go up. If there are financial concerns, the Financial Coordinator can help reduce these for the patient. The non-verbal communication that is lost by doing it over the phone is enormous. Face-to-face communication is still the best form of communication.
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