KNOWLEDGE IS POWER, and when it comes to periodontal procedures, knowledge can be profitable, even for PPO providers.
First, know your numbers. Review your procedure code count for the percentage of practice revenue coming from the hygiene department (30 percent is the goal); what percentage of that is periodontal procedures (again, 30 percent); and which CDT (Code on Dental Procedures and Nomenclature) codes you’re under-utilizing or not documenting.
Review your reports for these codes:
D0180: This is used for patients showing symptoms of periodontal disease, or risk factors such as smoking and diabetes. It can be reported the same service day as D4910 and doesn’t require a narrative with the claim. Providers can alternate with D0120 (unlike D4910 and D1110), and it’s usually payable higher than D0150.
D1310*: Nutritional counseling.
D1320*: Tobacco counseling.
D1330*: Oral-hygiene instructions (covered by some government plans).
D4921*: Gingival irritation, per quadrant. May be denied as global when used with D1110, D4341, D4342 or D4910. D1206*: Topical application of fluoride varnish. Patient does not have to have a moderate to high risk of caries to use this.
*Although these codes are usually not covered, most PPO plans allow dentists to collect from the insured. (See your CDT book for full descriptions.) Patients with PPO plans will pay more out of pocket, with many employers now selecting cheaper plans that cover one exam and prophylaxis over 12 months.
Educate your team on the importance of using the codes above for documentation even if you don’t charge—which you should, to build value and encourage future reimbursement, even if you adjust to zero at first. The American Academy of Periodontology recommends performing a complete periodontal evaluation (D0180) once a year.
Clinicians also often mistake the D4346 “scaling in presence of generalized moderate or severe gingival inflammation—full mouth, after oral evaluation” as a variation of a prophylaxis code. But these are distinctly different. Think of it this way: Let’s say you visited your physician for a routine physical and presented with risk factors including diabetes and smoking. Your doctor would perform the physical and provide data to support your risk-factor findings. This is the equivalent, in dentistry, of D0180. Your physician then notices you have conjunctivitis in your left eye and recommends that it be brought under control before you can treat and manage your risk factors. This is equivalent to a D4346.
If a patient is told she needs “a different kind of cleaning,” that sounds like making a choice between a basic car wash and a deluxe—knowing it’s going to rain tomorrow. The patient might not understand the significance of owning her infection. Thus D4346: an active bacterial infection that, if treated, can be reversed.
From a professional standpoint, code for what you see and what you do. By submitting a patient’s full periodontal charting to include bleeding sites and narrative supporting risk factors, you’re following the CDT Code and the ADA’s recommendations.
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