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Debbie Seidel-Bittke, RDH, BS is known as a top dental consultant by Dentistry Today.

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3 Steps to Expedite Dental Insurance Payment for Your Patients With Periodontal Disease

By: Debbie Seidel-Bittke, RDH, BS

October 3, 2014

As a dental practice management consultant and an expert advisor for Trojan  Professional Services, I am frequently asked questions about the dental hygiene appointment. One fact that will remain the same is the patient chart notes.

Why is documentation so important for the dentist and anyone writing patient notes?

Profits are important and patients do not want to pay a lot of their own money especially if you do bill patients insurance.

Many times when working with clients of Dental Practice Solutions, we see offices struggle to receive electronic insurance (via e-submissions made) payments within three weeks. One of the biggest reasons is due to incorrect or incomplete documentation.

As an expert consultant on “Ask the Consultant” for Trojan Dental Professionals“, I get a lot of questions about dental insurance billing, specifically for the periodontal patient.

The number one question I receive is “Can we alternate periodontal maintenance with a prophy when our patient has completed scaling and root planing and their insurance only pays for a periodontal maintenance two times a year?”

Here is the answer I gave an office the other day:

“Once a perio patient, always a perio patient.” If the patient receives CDT Code 2015: D4341 or D4342 they will become a Perio Patient for life. i.e. Perio Maintenance CDT Code 2015: D4910

Similar Example: If a patient has diabetes and they see their doctor and, one day, years later, at the routine doctor visit, their glucose levels look good, they will still continue to be checked routinely to be certain their diabetes is stable. These blood tests will be completed at routine visits and most likely for the rest of their life. Only their medication dose and/or elimination will be changed.

Periodontal disease is a disease with the same inflammatory influences as diabetes. Therefore, you will have your dental hygiene patient return for routine visits (evaluation) and their insurance will be billed as CDT Code 2015: D4910.

So the short answer is that you will keep perio therapy patients in Supportive Perio Therapy = CDT code 2015: D4910

You will never alternate between D1110 and D4910. Please read the definition for CDT Code 2015: D1110. The description of this code states healthy gums. A periodontal diagnosis does not describe healthy gums and may require some light

scaling/root planing subgingivally, etc., etc., at times.

How Does Specific and Thorough Documentation Help Our Office?

Step 1. In real estate they say “Location! Location! Location!”

And in dentistry we need to think “Document! Document! Document!”

When in the trenches working with client offices, most of the time we will see documentation that states the service completed. What is important for your office to be paid is the correct documentation which includes thorough notes.

Hygienists treat patients with periodontal disease daily and in order to receive payment for scaling and root planing followed by periodontal maintenance, you must write down the correct description of the patient’s periodontal status.

The American Academy of Periodontology has a wealth of information on their website to help you get this documentation correct the first time. The American Academy of Periodontology has specific guidelines for documentation and treatment of for example Chronic Periodontitis.

When you treat a patient who has a diagnosis of Chronic Periodontitis  your notes will include words such as: chronic, generalized, localized, moderate, severe, edema, erythema, gingival bleeding upon probing, and/or suppuration. Other information you want to make note of are: edema, erythema, range of probing depths (Include your perio chart attached to the insurance e-claim), radiographic bone loss, etc.

Another great way to not only communicate the disease process is by educating your dental hygiene patient and using intra-oral photos. These photos now become an important piece of your legal documentation, the billing process and your photos will expedite the payment of your patient services.

Step 2.  Pictures paint a thousand words!

If a dental hygiene patient presents with heavy supra-calculus, take an intra-oral photo of the area, show the patient and then use this for your insurance billing.

Does the patient have gingiva that bleeds easily with BOP? Again, take photos, show your hygiene patient and then send these with the e-claim to the patients’ insurance company.

Think about being a proactive advocate for your dental hygiene patient. Show your patient what you “see” in their mouth, share the valuable information with your them and also share this with the insurance company.

Step 3

Once you have this valuable information attach this to the e-claim you will send off to the insurance company.

Conclusion

Net profits are a big concern to every business owner. These three steps will expedite insurance payment and increase profits to your dental office! Using the intra-oral camera will also add value to your dental hygiene appointment for every patient.

Insurance reimbursement will occur more quickly with proper documentation and the intra-oral photos not only assist your patients in understanding the value of the services you have recommended but it will help the insurance companies understand why you have submitted this claim for reimbursement.

Would you like to read more about the American Academy’s Parameter on Periodontal Disease Classification? Just click on this link: AAP PERIO CLASSIFICATION

I would enjoy hearing about you and how your electronic claims are being received on the insurance companies end? Are you receiving payment quickly?

Do you have any insurance billing questions? Please ask away! I always enjoy answering your questions, especially when they are about the dental hygiene department and insurance billing, etc!