After Scaling and Root Planing Should we Bill a Prophy or Perio Maintenance?
June 26, 2024
After performing Scaling and Root Planing, the question arises: can we bill for a Prophy or do we need to continue billing for Perio Maintenance?
In some cases, the choices may seem straightforward, such as billing for a Prophy when a patient has healthy gingiva, however, determining the correct code to bill after Scaling and Root Planing can be a bit more nuanced, as it depends on the specific needs and circumstances of the patient.
Never should we diagnose or bill simply because the patients insurance will or will not cover a specific procedure or service.
First, let’s break down the two options:
- Prophy (D1110)
A Prophy is a routine dental cleaning that is recommended for patients with healthy gums and minimal plaque or tartar buildup. This type of cleaning is typically performed every six months to maintain good oral health and prevent periodontal disease.
- Perio Maintenance (D4910)
Perio Maintenance (D4910) is more than just a cleaning. When a patient has been treated for active gum disease with scaling and root planing this procedure is typically performed every three to four months to help manage and stabilize the disease.
Our overarching goal is to halt oral inflammation which will also support total health.
*Read the AAP Parameter for Periodontal Maintenance in resources listed below.
When a patient has oral inflammation, year-after-year, we know (evidence based research) that this patient is now at high risk for other systemic diseases such as, high cholesterol, high blood pressure, heart attack, stroke, diabetes, rheumatoid arthritis, Crohn’s disease, Parkinsons and Alzheimers disease, etc.
The Question
Which CDT code should we bill after a patient has completed a D4341 or D4342 (Scaling and Root Planing)?
The answer to this question largely depends on the total health of each individual patient.
In general, if a patient has completed Phase I therapy (D4341 or D4342), and ‘if” they have high blood pressure (or any systemic inflammatory condition), diabetes, etc, – any systemic inflammatory disease, you will have the patient return in three months for D4910 if they present healthy at the 4-6 week re-evaluation appointment (AKA: Periodontal Maintenance D4910).
When a patient has systemic risk factors, i.e. high blood pressure, high cholesterol, diabetes, etc, this indicates that they are at risk for life-altering conditions such as: stroke or heart attack, Parkinsons, Alzheimers, etc, etc.
Imagine, in today’s world of dentistry, we no longer “treat a tooth,” we are treating the whole body and our goal must be “halt oral inflammation” and “help patients live a longer-healthier life.”
“Inflammation in the oral cavity year after year, typically creates a cascade of other systemic diseases.”1
In order to accomplish this goal of total health, closely monitor patients and schedule more frequent preventive care – hygiene appointments. It is beneficial to the patient when you include laser bacterial reduction (LBR) at routine preventive care appointments. LBR affects the cells at the mitochondrial level. It is one important piece to helping our patients live a longer – healthier life.
When your patient has a history of inflammatory systemic disease use code D4910, Perio Maintenance and LBR (If legal for a hygienist to use) to ensure that your patient receives the necessary care to manage complete health.
On the other hand, if a patient has completed a D4341 procedure but does not have a history of gum disease or other systemic health issues, it may can be appropriate to bill for a Prophy D1110.
It’s important to note that dental billing can be complex, and it’s crucial for dental providers to accurately code and bill for services to ensure proper reimbursement and compliance with insurance guidelines. As such, it’s recommended to thoroughly review the patient’s treatment plan, medical history, and oral health status before determining the appropriate billing code.
In addition to considering the patient’s individual needs, it’s also essential to communicate openly and transparently with the patient about their treatment and benefits to routine preventive care maintenance. Communicate and continue educating patients about optimal oral health will lead to a longer, healthier life.
Consistently communicate to your patients, “Prevention costs a little money and treating disease costs a lot of money. Oral disease affects your total health!”
Speak with empathy and passion/enthusiasm to help them live a longer, healthier life. Understand your patient’s values. Is money an objection?
If you don’t believe you can help them live a longer, healthier life, neither will they!
Help your patients who use money as an objection, understand that spending money to treat their disease means less money spent in the future when they return for preventive services. Help patients understand the value of spending money on prevention to save money on treating oral and systemic disease.
Discuss the importance and the benefits of ongoing preventive maintenance so your patients will better understand the value of preventive care, and the significance of routine hygiene (AKA: “preventive care”) appointments in maintaining their total health.
Conclusion
Determine the appropriate billing code after a patient has completed Scaling and Root Planing (D4341/D4342), at the next appointment, when they return for the 4-6 week re-evaluation.
Your 4-6 week re-evaluation will be billed as D4910. If you have treated your patient using soft-tissue diode laser, include LBR in the Periodontal Maintenance appointment. If you are able to use soft-tissue diode laser (LBR/D9997) in your state, you will use this all future hygiene preventive care appointments.
Should we bill a Prophy (D1110) or Perio Maintenance (D4910) after our patient completes SRP, really depends upon:
- Your patients total health
- What your patient’s insurance will pay for
And as always, know that we have an ethical responsibility to do what is in the best interest of our patient; not what their insurance will pay for!
At Dental Practice Solutions we recommend Perio Assisted Laser Therapy when treating patients with SRP. At the 1st appointment (D4355) Gross Debridement and the 1st Periodontal Maintenance Appointment (4-6 week re-evaluation) we recommend including Laser Bacteria Reduction.
The Scaling and Root Planing procedure includes careful consideration of the patient’s total health status. While both a Prophy and a Perio Maintenance are valid options at the end of Phase I therapy, it’s essential to select the appropriate service and CDT code that best aligns with the patient’s individual circumstances to ensure they receive the necessary care and support to maintain their total health.
By prioritizing patient-centered care and clear communication, dental providers can improve patient outcomes and overall satisfaction with their dental experience.
- Does your office feel challenged by the sequencing and billing of gingivitis and periodontitis treatment?
- Do you have questions about this blog? We understand it can be confusing and we are hear to clear up any confusion.
Consider booking a quick call. We can help!
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