Fast Facts: Coding Episode 2
[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Coding Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Teresa Duncan, MS.
[Teresa Duncan, MS]
Hello, and welcome to another edition of your Coding Fast Facts. Today we have some procedure codes which are my favorite, and I'm really just kidding when I say that, today we're going to tackle 4910, which is the periodontal maintenance code, and the 4341 and 4342 codes, which, of course, are your scaling and root planing codes. So let's just get the 4341 and 4342 codes out of the way. The distinction with those. So 4341 is by far the most common one that you're going to see, and that is periodontal scaling and root planing, four or more teeth per quadrant, and I will say that probably 90% of the scaling and root planing that goes on out there has to do with the full quadrant vs 1-3 teeth, which is the 4342 procedure code. So that's really the only difference there. So when I talk about the scaling and root planing codes, I'm really talking about those two codes, and it does depend on how many teeth that you have involved in the procedure. So just real quick, let's go over the descriptions of this procedure. This procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from the surfaces. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic in nature. Root planing is the definitive procedure designed for the removal of cementum and dentin that is rough and or permeated by calculus or contaminated with toxins or microorganisms. Some soft tissue removal occurs. This procedure may be used as a definitive treatment in some stages of periodontal disease and or as a part of pre-surgical procedures in others.
There's a lot of flexibility in that procedure code description. One thing that I'd like to point out is we do talk about the tissue being contaminated with toxins and microorganisms, and I'm just going to challenge you. Is that something that you discuss with your patients? And if not, why not? Because really we do need to let them know. It's not a pretty situation and we need to let them know about that.
Now let's talk about periodontal maintenance. So this procedure, this is the description here. 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. Okay? So just remember that adds in the implant replacements in there. So implants are included in the definition of periodontal maintenance. It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions. Site specific scaling and root planing were indicated and polishing of the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.
And so when you are performing these procedures you are going to have a grade attached to the periodontal maintenance so when you have the scaling and root planing you of course will have the staging that will have happened using the new AAP guidelines and then the periodontal maintenance that is at the point where you're going to take a look at their grade of healing and you will then at that point have a grade established to that patient. Now, when it comes to documentation from a coder's point of view, from my point of view, having good staging and grading information Is going to help me get your claims paid. Now more than ever, documentation is a big factor in getting your scaling and root planing claims paid. Most of the time when I help people with submission issues it's because they're missing documentation. So I'd like to just give you the most common mistakes I see.
Number one, the probing is not complete. It doesn't have everything I need furcation, pus suppuration, clinical attachment level indicated, not just probing depths. I need bleeding points. I need it to be a very colorful periodontal chart and here's the kicker - it needs to be within twelve months. So most of the time the insurance carriers will not approve benefits doesn't mean that you didn't need to do it. That's not the determination they're making. They're determining whether or not benefits should be applied. They won't do it if the documentation submitted is not within that parameter. So probing within twelve months and please keep in mind that radiographs typically should be within 24 months but I'm seeing more and more plan designs where it's within twelve months as well. So really a good rule of thumb is to make sure that your probing and your radiographs are all within one year and that way you should have really current information and that just helps you also with your conversations with the patient. That was a pretty loaded Fast Facts. Hopefully that was very helpful for you and until the next time, thank you for tuning in.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts - Coding Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at www.dentistrx.com. We'll see you next week for another Fast Fact!