We hear this question quite frequently from our patients who have completed their gum treatments. by Dianne Glasscoe-Watterson, RDH, BS, MBAdglasscoe@northstate.net, Dear Dianne,I have a patient who went through root planing/scaling and has been on periodontal maintenance for the last 10 years (D4910). (A patient-friendly brochure detailing the difference between a standard "cleaning," "root planing," and "perio maintenance procedure" may be purchased from Stepping Stones to Success, www.steppingstonestosuccess. When you have new patients come into your office and they present with numerous areas of recession but healthy gum tissue overall, you may wonder if it is appropriate to use the periodontal maintenance code. The other problem is that the hygienist will do an assessment but there may be a lot more calculus present than is considered a regular prophylaxis procedure. . The code for periodontal maintenance indicates that active periodontal disease is present and D1110 indicates otherwise. CDT code D4910: When should I bill Periodontal Maintenance? 2018-2026 One Dental Billing | All Rights Reserved. Sometimes dental offices alternate using the periodontal maintenance code and the prophylaxis code with patients who have a three-month recall. Patients should be told in advance that plan provisions may not provide for reimbursement of D4910 for extended periods. Periodontal scaling and root planing - four or more teeth per quadrant; D4342 Periodontal scaling and root planing - one to three teeth per quadrant; D4910 Periodontal maintenance; Example ICD-10-CM Code(s) A69.1 Other Vincent's infections; E11.9 Type 2 diabetes mellitus without complications; K03.6 It seems that each carrier has different policies/limitations for this procedure. It is intended to control local irritational factors., The Periodontal Maintenance (CDT Code D4910 periodontal maintenance) is a post-therapeutic procedure used to maintain the healthy results of periodontal therapy, not to prevent disease in healthy patients. After 24 months, D4910 is not payable unless D4341 or D4342 are performed again under a new prior authorization. We have office hours in both our Beavercreek and West Chester locations to serve your periodontal needs. As with all claims, the more information provided with the initial claim, the better the chance for a timely benefit payment. . A pre-procedural rinse and irrigation post-procedural with an appropriate antimicrobial, such as Povidone-iodine or Chlorhexidine, is the Gold Standard. This is our standard of care. D4910 Periodontal Maintenance Treatment: Attachments: Periodontal Charting/Perio Chart. Periodontal scaling and root planing - 4 or more teeth per quadrant $290 $110 $180 D4342 Periodontal scaling and root planing - 1 to 3 teeth per . Since payers think about D1 1 10 a piece of periodontal support, anticipate that repayment should the substitute advantage of a prophylaxis. Typically a time lapse between the active therapy and the crevicular treatment is required, often at least four to six weeks. In the United States and other countries a billing code is used and more money is charged for the service. com.) Documentation is critical in each of the three examples discussed in this article. A series of articles published in the ADA News between 2006-08 discussing Top 10 concerns about dental claims remains relevant today. This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. The oral assessment (D0120 or D0180) is by and large gave two times a year and is dependent upon the run of the mill one evaluations each a half little while evaluations each year constraint. Code D4342 might have a fee that reflects three-fourths of the fee charged for D4341. In addition to the above, the following codes will be reimbursed at the following rates for all dates of service on or after July 1, 2009 for all HFS Dental Program beneficiaries: Code Procedure Old Fee New Fee D9110 Palliative (emergency) Treatment of Dental Pain-Minor Procedures $14.10 $55.00 All rights reserved. Explain clearly to your patients about why "just a cleaning" may not be the best choice for their current oral condition. Periodontal support incorporates eliminating any new plaque and math that might have framed since the patients last periodontal treatment arrangement as well as site explicit scaling and root arranging where shown and cleaning the teeth. Consider filing a claim when reporting D4910 with the accompanying story: If periodontal support (D4910) is denied, if its not too much trouble, give the substitute advantage of a prophylaxis (D1110). Consider holding random chart audits in your practice as a team. The continuous periodontal maintenance (D4910) interval is typically ninety days yet the not entirely set in stone by individual need. (Example: Less than six months interval.). In this article, we will explain why this maintenance routine is so important. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered. Some considerations include the following: Regardless of the ADA description for D4355, most carriers regard it as a code intended only for extreme cases and do not typically provide a separate benefit. Beware! Patients also need to understand they are not there to get their teeth cleaned. This is the information to communicate to patients. Ongoing periodontal maintenance does not include the periodic oral evaluation or . Click Here to Read the Warranty Policy: https://www.hufriedygroup.com/services/warranty-returns. If this gentleman moved to a different city and went to a dental office as a new patient, where after examination they saw no signs of active disease, how would they treat him? In the past, dental hygienists have used a D4910 (periodontal maintenance) code at the 5-week re-evaluation appointment, which we did not submit to insurance, and which the patient was responsible for in addition to the cost of the . periodontal maintenance code D4910. Dynamic periodontal treatment might be accounted for as D4341, D4342, D4240, D4241, D4260, or D4261. The continuous periodontal maintenance (D4910) interval is typically ninety days yet the not entirely set in stone by individual need. The ADA coding system undergoes updating and revision periodically. This method saves a patient money as a prophylaxis is typically 100 percent covered, whereas periodontal maintenance may be covered partially or not at all. It is intended to control local irritational factors. Said differently, a prophylaxis is for people who may have gingivitis but no signs of active periodontal disease. Similar to a regular teeth cleaning, periodontal maintenance removes tartar buildup from the teeth. This means no disease is present.) All throughout the day, we treat them one by one. D4910 ; Periodontal maintenance . The documentation should indicate that a prophylaxis was performed as part of the D4910 procedure. Unlike a normal, preventative cleaning, periodontal maintenance is a treatment prescribed to combat periodontal disease. When you use the periodontal maintenance code correctly, you know that you have met your ethical responsibility and that you are billing for the treatment you provided to meet a patient's individual needs. The continuous periodontal support (D4910) visit incorporated a prophylaxis (D1110). The clinical notes ought to mirror the way that a prophylaxis was given as a piece of the D4910 methodology. Some computerized patient management software programs, stand-alone devices and programs, such as the DENTRIX periodontal chart where you can color code areas with different colors, (Red for BOP, green for mobility, etc.) We are not talking about the almighty dollar. Dental Claims Academy is a resource for dental professionals who wish to feel empowered when handling their coding and billing. The clinical experience of the D4910, as compared to the D1110Adult Prophylaxis, should be quite different. Periodontal upkeep (D4910) is continuous and helpful in nature, not preventive. Note: The reimbursement for D0180 may be re-planned as D0120. Could you give us any advice on this matter?Christy. Thanks for spotlighting this important issue! Does it seem like patients only accept what their insurance will pay for? After. Some offices have two consistent, however unique, expense levels for D0180, contingent upon whether the method is accommodated the new entering the training) or laid out (review) D4910 patient. The Periodontal Maintenance (CDT Code D4910 periodontal maintenance) is a post-therapeutic procedure used to maintain the healthy results of periodontal therapy, not to prevent disease in healthy patients. No mention of a time period following periodontal treatment is provided in the Code. If there are unusual circumstances that require a different interval of treatment than the one specified in the patient's plan documents, the dentist should provide documentation with the original claim submission. As mentioned previously, when a patient has Diabetes or high blood pressure, the doctor will ask the patient to be examined frequently because the disease is likely to return. Other Periodontal Services D4910 Periodontal Maintenance Y 54.00 D4920 Unscheduled Dressing Change (By Someone Other Than Treating Dentist or Their Staff) Y 24.00 Prosthodontics (Removable) Complete Dentures (Including Routine Post-Delivery Care) D5110 Complete Denture - Maxillary Y 375.00 D5120 Complete Denture - Mandibular Y 375.00 One more way to communicate the importance of more than a prophylaxis is to show the patient radiographs of their teeth, the surrounding bone and/or intraoral photographs of the diseased areas, bleeding staining, plaque, calculus, etc. D1110 consists of the removal of plaque, calculus and stains from thetooth structures. 2023 Endeavor Business Media, LLC. 15508 W. Bell Road Suite 101 PMB 431, Surprise, AZ 85374. D4910 is indicated following active periodontal therapy, per the descriptor. Periodontal support is acted within the sight of dynamic illness while a prophylaxis (D1110) or scaling in presence of summed up moderate or extreme gingival inflammation (D4346) is performed to forestall sickness. For some patients the most challenging part is the finances. Two years later, what if the patient exhibits signs of disease again bleeding on probing, inflammation, and increased pocket depths? D4910 Periodontal maintenance $164 $68 $96 ADA CODE PROSTHODONTICS, REMOVABLE USUAL FEE* YOUR COST YOU SAVE D5110 Complete denture - maxillary $1,929 $685 $1,244 D5120 Complete denture - mandibular . Correctly coding dental procedures can affect how much you collect on your insurance claims, and it can affect the compliance of your dental practice. Hu-Friedy has created a collection of procedural instrument kits that follow American Dental Association (ADA) - Current Dental Terminology (CDT) Coding. By stable, you mean he has no continuing loss of attachment or supporting bone and no signs of active disease. Show them actual tooth mobility if it exists. 2023 Endeavor Business Media, LLC. Periodontal pathogens reside in the sulcus and on the plaque and calculus. Do not alternate between periodontal maintenance and prophylaxis, as it indicates a change from a diseased state to healthy state (or vice versa), on a regular basis. These pathogens are what will cause tooth loss in periodontal patients. The descriptor for D4910 provides clear guidance as to its usage and what is included in the procedure. The gum tissue is healthy with a minimal amount of plaque and calculus. I hope this helps to get everyone in your office calibrated concerning periodontal maintenance. The descriptor for D4910 periodontal maintenance includes removal of bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planning as well as polishing where indicated. Even though that is not what the code description states, the general opinion is that D1110 should apply to all adult cases not involving periodontal disease, with or without gingivitis, and including both subgingival and supragingival calculus removal. If the treatments do not meet this requirement, it can be a write-off for the practice. Most patients will require perio maintenance cleanings every three to four months, but some patients who are very high risk need them as often as every six weeks! How should you address this issue? Free Narratives and Attachment list for dental insurance claims. When and for what length of time is periodontal maintenance the appropriate code to use? Most carriers allow a lesser benefit for a full-mouth, four quadrant D4341 performed on the same day than they do for a two-quadrant-per-visit procedure. D4910-Periodontal Maintenance . Begin each preventative appointment with an Evaluation Kit and add the supplemental treatment kit based on the patient assessment. However, if the treating dentist deter-mines that a patient's oral condition can be treated with a routine prophylaxis, delivery of this service and reporting with code D1110 may be appropriate." So they are saying that some people can be maintained with a prophylaxis. It is our role as a healthcare provider to read the research, know the science, and share it with everyone who needs to know. It involves both scaling and root planing, meaning tartar must be removed from deep between the teeth and gums. An oldie but goodie: pre-rinsing for all our patients, Championing Glucose Monitoring in Your Practice, The Impact of the Pandemic on Oral Health, periodontal maintenance and a routine prophylaxis. All four tests can detect pathogens that are associated with periodontal disease. Does your hygiene schedule seem empty or stuck? The CDT-4 and the revision process is a function of the Code Revision Committee, which includes representatives of both the ADA and the insurance industry. The periodontal support patient (D4910) probably gone through either SRP or periodontal medical procedure (gingival fold or bony medical procedure) before periodontal upkeep (D4910). This can happen through early intervention, successful treatment, and great home care. You told your patient about the research and science behind the disease and you also need to tell them that periodontal disease is episodic. indicate the date of the last periodontal therapy such as scaling and root planing for each quadrant. Thus, resubmission of diagnostic materials would not be necessary on a patient whose periodontal therapy was covered by the payer. If periodontal pockets remain at the D4910 appointment, the patient could be treated with LDAAs or surgical options. This article should discuss what holiday stress is, signs of holiday stress, how to avoid it and how to reduce it if you have it. It is the role of a healthcare provider to educate and communicate to patients exactly what type of care is appropriate for their overall health. If new or repeating periodontal illness shows up, extra demonstrative and treatment strategies must be considered. This is when you have effective communication skills that you can overcome the financial barriers to accepting non-surgical periodontal care. Enter your email address to receive exclusive news, updates and offers from HuFriedyGroup. BANA is an enzymatic test for periodontal pathogens, and the other is a video microscopy test called BioScan.Any of these above listed tests can provide the type of important information dental practices and patients may consider prudent. As a result, alternating codes is never appropriate. D4910, periodontal maintenance. Follow-up patients who have received active periodontal therapy (surgical or nonsurgical) are appropriately reported using the periodontal maintenance code D4910. The ADA Council on Dental Benefit Programs continually receives and addresses a variety of dental claim submission and adjudication questions from member dentists and practice staff. A few specialists consider it inappropriate pinnacle a similar professional to substitute D4910 with a prophylaxis (D1110). Perio maintenance is the short way of saying periodontal maintenance. PPO agreements might restrict repayment for the utilization of gingival water system in periodontal support. If a patient with recession shows no active signs of disease, such as bleeding on probing or pocketing, the dental professional may decide in this instance that using D1110 is appropriate. You may have patients that you have treated with root planing and scaling in the past and now their gum tissue is healthy with minimal amounts of plaque and calculus. Individuals may recommend code changes. A sample narrative is: If D4910 benefits are not available, please consider an alternative benefit of an adult prophylaxis (D1110) as a prophylaxis was performed as part of the D4910. By going through these questions, you will have a deeper understanding of when to bill periodontal maintenance and when to use CDT code D4910. I advocate the extensive use of power scalers with thin inserts that are effective in reaching the depths of periodontal pockets for thorough debridement, touching every square millimeter of root surface multiple times, in addition to hand scaling where needed. Unfortunately, this is not the norm. Prevention and treatment, you are providing optimal care. When the documentation supports a prophylaxis, appeal the denial, and ask for an alternative benefit of a prophylaxis because it was part of the D4910 procedure. Our office has two dentists who are recent graduates, and six hygienists. When there is a new area of bleeding upon probing (BOP) or a new 5-mm pocket, now is the time to sit the patient upright in the chair and discuss early intervention. You will be redirected once the validation is complete. Four outside labs have periodontal tests: two are culturing services Oral Microbiology Testing Service (OMTS) and Oral Microbiology Testing Lab (OMTL). Not everything is a prophylaxis or perio maintenance. Periodontal maintenance is often denied, because many . The lack of details of what was performed and why it was performed is an ongoing problem for most dental teams. No matter where you live, review the billing code description. A loose tooth is not a pretty sight to see! Periodontal therapy has been completed, newly exposed root structure and altered architecture often make debridement of plaque and calculus more difficult. The Code Revision Committee recently made a "clarification to the original intent" of D1110 and stated that the word "or" should be removed from the definition. Certainly a patient's home care is important, but people with established periodontal disease cannot stop or control their periodontal problem without good professional care. A prorated amount per tooth is also likely. The give a couple of generic personal examples. Not many hygienists have returned to work; What do you do? One reason hygienists may choose to eliminate the periodontal maintenance appointment is for financial reasons. Periodontal care through early intervention, successful treatment, you mean he has no continuing loss of attachment or bone! 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Reside in the procedure pockets remain at the D4910 procedure signs of active periodontal therapy ( or... Suite 101 PMB 431, Surprise, AZ 85374 newly exposed root structure and altered often. In advance that plan provisions may not be the best choice for their current oral condition ADA coding undergoes! 431, Surprise, AZ 85374 maintenance routine is so important advice on this matter? Christy payable D4341... Reimbursement for D0180 may be re-planned as D0120 what was performed as part of the fee charged D4341! In the code other countries a billing code description insurance will pay for treat! Ppo agreements might restrict repayment for the service who are recent graduates, and pocket. A timely benefit payment matter? Christy we hear this question quite frequently from our who! After 24 months, D4910 is not a pretty sight to see problem for most dental teams needs!