Many patients resist regular periodontal maintenance visits after a definitive periodontal scaling. periodontal maintenance code D4910. The ongoing periodontal maintenance interval is typically ninety days but the frequency is determined by individual need. QUIZ: Test Your Ultrasonic Insert Knowledge! Follow-up patients who have received active periodontal therapy (surgical or nonsurgical) are appropriately reported using the periodontal maintenance code D4910. 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. Radiology Guidelines: Are Your Patients Over-Exposed? 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. Our goal as clinicians is to decrease periodontal bacteria that causes inflammation and maintain periodontal health. (2003). So why is it some hygienists dread them on their schedule? Her mission is to help hygienists and their practices develop a hygiene department that delivers cutting edge and lifesaving care to patients. D4910 periodontal maintenance According to the Code on Dental Procedures and Nomenclature (the CDT Code), D4910 periodontal maintenance, is performed 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. However, if the treating dentist determines 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.â Periodontal maintenance - Code D4910 - is a common service provided by both general and specialty practices. If you have periodontal disease that has resulted in bone loss, gum âpocketsâ deeper than 4 millimeters, bleeding gums, exposed root surfaces, or if you have had periodontal surgery or root planning to treat periodontal surgery or root planning to treat periodontal disease, a regular cleaning is not appropriate. Assisted Hygiene Part 1: Is Your Office Prepared? Getting reimbursed for Periodontal Maintenance (D4910) is a pain. Evaluate your perio maintenance patient with accurate data and compare the findings from 1, 2, or 3 years past. Managing Caries Risk for Patients with Sjögren's Syndrome, Effective Resources for Patients with Special Needs, Creating a New Learning Experience for Virtual Meetings, A century and counting. 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. D4910 is a procedure that follows periodontal therapy and continues at varying intervals, determined by the dentist's clinical evaluation of the patient, for the life of the dentition. Added on Sunday, January 01, 1984 Status changed on Wednesday, January 01, 2003 to: No maintenance for this code 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. When patients understand the value of their treatment, they will be more comfortable with paying for the correct procedure. By definition, the 4910 periodontal maintenance code is defined as the procedure following periodontal therapy and continues at varying intervals determined by the clinical evaluation. 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. The periodic evaluation (D0120) or D0180 is submitted as a separate procedure on the same date of service. Do it right, and you can add thousands of dollars to your bottom line. D4910 - Periodontal Maintenance* D4341 - Periodontal Scaling and Root Planing - 4 or more teeth per quadrant D4342 - Periodontal Scaling and Root Planing - 1-3 teeth per quadrant . However, some Medi-Cal adult Remember, Periodontal Maintenance is not a one-size fits all code! As a result, alternating codes is never appropriate. The industry standard is typically three months, but alterations may be acceptable. All Adults: Created Date: These patients may ask you if they can just "get a regular cleaning." I have had personal success with varied intervals from 2 months (for non-compliant geriatric patients) to 4-5 months. Several coaches and consultants have ways to divide up your operatory time, and at best, any of these protocols are guidelines. It includes removal of bacterial plaque, calculus, from supra and sub-regions, and SITE specific SRP where indicated, as well as polishing the teeth1. Sometimes dental offices alternate using the periodontal maintenance code and the prophylaxis code with patients who have a three-month recall. * However, improving your reimbursement for Periodontal Maintenance doesnât have to feel like an uphill battle. Coding with Confidence. D5110 Complete denture maxillary $230 Dental professionals can be proud to recommend Colgate, a company known for both its researched products and its community outreach. Site-specific root debridement if indicated. The ongoing periodontal maintenance visit included prophylaxis (D1110).â RDH mag did a great article on this in Feb 2014, which includes info about the above narrative. It is intended to control factors that can cause irritation and inflammation. © Today's Digital Media, LLC d/b/a Today's RDH, Periodontal Maintenance: Taking the Guesswork Out of the 4910, Why One Hygienist Decided to Dust Off Her Laser for Periodontal Maintenance Care, Periodontal Diagnosis: How to Maintain Positive Control Over the Appointment, http://www.joponline.org/doi/pdf/10.1902/jop.2000.71.5-S.849, http://www.joponline.org/doi/pdf/10.1902/jop.2003.74.9.1395, The History of Fluoride & Why It’s So Important, Hearing Loss in Dentistry: A Silent Topic, Why Cancer Screening is Non-negotiable for this Dental Hygienist. This code includes removal of bacterial plaque and calculus from supragingival and subgingival areas, along with site-specific scaling and root planing. So what SHOULD you be covering in your 60-minute periodontal maintenance? TOP 10 CLAIM CONCERNS: ADA, NADP SHARE VIEWS ON DENTISTSâ CONCERNS. However, if the treating dentist deter-mines that a patientâs oral condition can be treated with a routine prophylaxis, delivery of this service and reporting with code D1110 may be appropriate.â So they are saying that some people can be maintained with a prophylaxis. SEE ALSO: Why One Hygienist Decided to Dust Off Her Laser for Periodontal Maintenance Care, DON’T MISS: Periodontal Diagnosis: How to Maintain Positive Control Over the Appointment. The periodontist could provide ongoing periodontal maintenance while the GP â¦ Although the CDT-4 definition of D4910 states that intervals for the procedure are determined by the clinical diagnosis of a dentist, it eliminates the words "periodontal evaluation" that were included in the CDT-3 definition, and does not make any mention of examination or evaluation in any other context. Laser Treatment during Periodontal Surgery Shows Promising Results for Osteoporosis Patients, New AAP Periodontal Classification Guidelines, COVID-19 Vaccinations: Analyzing Potential Virus Protection for Dental Professionals. Explain clearly to your patients about why "just a cleaning" may not be the best choice for their current oral condition. What are the changes? Explain to your patients that they have active periodontal disease, which requires you to remove bacteria and buildup from below the gum line with special instruments to help prevent further bone loss. VIDEO: What Hygienists Need to Know About Eyewear Use for Safety... INFOGRAPHIC: The Smart Choice in Patient Comfort, VIDEO: Hygiene Chat – Moisture Control vs. On a personal note, her free time is spent on the beaches of the Crystal Coast of NC, most often on horseback. common limitation is two per 12-month period or calendar year. The ADA code description and insurance reimbursement for this procedure have undergone changes in the past few years. Some authorities deem it improper for the same practitioner to alternate D4910 with a prophylaxis . It also includes the usual time between patient set up, break down, and the quick stop to the staff lounge to stuff down a granola bar in transit! 14. It may be tempting to use the prophylaxis code to help your patients save money, but ethically, you must bill out the procedure that you performed. Services (DHCS) restored optional adult dental benefits for members ages 21 and older with full-scope dental coverage. But this one team wants to do the first follow up as a âfine scaleâ using the D1110 and then all of the subsequent appointments will be periodontal maintenance. Retrieved from, Position Paper: Periodontal Maintenance. The code for periodontal maintenance indicates that active periodontal disease is present and D1110 indicates otherwise. I’d like to close this article by leaving you some bread crumbs to ponder for your next 4910 patient. Erika Spring, RDH, MEd, is the Founder and Owner of Spring Innovative. Dry mouth means that patients with Sjögren’s syndrome are at increased risk for dental caries. o When submitting your first claim for a D4910 to MetLife, please have your attending Dentist provide How should you address this issue? The bottom line is that periodontal maintenance treats active disease, while a prophylaxis is preventative. 211 East Chicago Avenue T 312.440.2500. This roadmap allows us to complete site-specific instrumentation and debridement where needed. Periodontal Maintenance (D4910) Perio Maintenance helps patients sustain periodontal health and aids in the prevention of bone loss. Ongoing periodontal maintenance (D4910) does not include a periodic oral evaluation (D0120) or comprehensive periodontal evaluation (D0180). So whatever timeline you use or have been given, I say go with it and just be flexible! 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. D4910 Periodontal maintenance $25 Additional periodontal maintenance procedures (beyond 2 per 12 months) $55 Periodontal charting for planning treatment of periodontal disease $0 Periodontal hygiene instruction $0 Removable Prosthodontics Includes up to 3 adjustments within 6 months of delivery. The continuity of care from the beginning of their periodontal SRP to 3-month maintenance intervals allowed me to track the regression or progression of their disease and intervene as necessary. The ADA Council on Dental Benefit Programs continually receives and addresses a variety of dental claim submission and adjudication. My focus this month is not to dissect the code and what it means or how to code, but to help hygienists perform the clinical procedure 4910 with efficiency and ease. Is D4346 a procedure followed by periodontal maintenance reported with D4910? Virtual Meetings can be a great experience! It is our responsibility to provide resources to assist them in having good oral hygiene and more effective daily routines. D4910 CODING FOR PERIODONTAL MAINTENANCE. D4910 Periodontal Maintenance Treatment: Attachments: Periodontal Charting/Perio Chart. Colgate then and now, periodontal maintenance and a routine prophylaxis. Hygienists are critical in this role. You can also help them visualize the inflammation and swelling in their gum tissue by using the probe feature of Gum Health Physical. Additional prophylaxes are optional and may be charged to the patient. Maintenance intervals for at-risk patients can and should vary. Otherwise, finding a history may be a challenge. Chicago, Illinois 60611 F 312.440.7494. www.ada.org. We now know that the inflammatory burden that stems from oral infection can have a relative effect on systemic health such as diabetes, RA, and vascular disease. D1110 consists of the removal of plaque, calculus and stains from thetooth structures. She believes if practice members individually and collectively commit to continual improvement, then clinical excellence will be the natural outcome. It is intended to control factors that can cause irritation and inflammation. My focus this month is not to â¦ Studies, past and current, regarding periodontal guidelines follow three-month intervals2. D4910 periodontal maintenance 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. Within your 60 minutes, of course, a comprehensive medical history review is indicated, as well as time for a doctor exam per your office protocols. It is an advanced bacterial infection that causes tooth loss and gum recession, and is preceded by gingivitis. All rights reserved. Twenty years later, what we know now is the days of aggressive osseous surgery have seen a shift to non-surgical treatment and proactive maintenance targeting biofilm. Now letâs dissect this longer and even more confusing description and break it down into what matters most. According to Dentistry IQ you must compare these two codes to understand which procedure is the correct one to bill for. J Periodontol 2000;71:849-850. The goal of periodontal maintenance is to maintain periodontal pockets by removing biofilm accumulation after initial periodontal therapy (SRP). D4910: Periodontal Maintenance: $88: 504 - Prosthodontics (Removable) Code Service Fee; D5110: Complete Denture - Maxillary: $884: D5120: Complete Denture - Mandibular: $884: D5211: Maxillary Partial Denture - Resin Base (including any conventional clasps, rests and teeth) $865: D5212: â¢ If the dentist is a periodontal specialist (periodontist) Creating an environment wrapped around the meeting can be exciting and bring great memories for the entire team! The other reason is that most third-party payers do not cover care at three-month intervals.There is clear evidence for the necessity of a season of maintenance. It consists of appointments at regular intervals (every 3, 4 or 6 months) where the teeth are scaled and polished, plaque and bacteria are removed, and the root surfaces are kept smooth and deposit free. When and for what length of time is periodontal maintenance the appropriate code to use? Are you finding the BOP and pocket depths are the same or is there a medical or oral-systemic link risk factor that pops-up? Services not covered by the patient's insurance should be paid for by the patient. We include a narrative to all 4910 claim that reads, âIf periodontal maintenance (D4910) is denied, please provide the alternative benefit of prophylaxis. If so, you NEED to make adjustments and consider the possibility for bacterial testing, a medical referral, or something as simple as an adjusted recare interval based on the patient’s needs. One of the things I personally loved about practicing in a perio office was the ability to see my patients from start to finish. Of course, I always tell people that following is a periodontal procedure; we should be doing periodontal maintenance, D4910. Coding should not be dependent on what insurance covers but instead should be based on the individual's actual treatment. I too, as a consultant, provide timelines and time frames to help clinicians stay efficient. Narrative: For CIGNA AND METLIFE (mandatory documentation): Include the SPR Hx(history) as narrative. Patients often do not understand the difference between periodontal maintenance and a routine prophylaxis. COVID-19 Vaccine: Will Vaccinations Be Mandatory for Dental Professionals? The bottom line is that periodontal maintenance treats active disease, while a prophylaxis is preventative. D4910 is a procedure that includes site specific root planing as needed in patients who have been treated for attachment loss. As a practicing hygienist, Erika learned how communication and systems go hand-in-hand to increase case acceptance. Periodontal pathogens can entirely repopulate previously scaled teeth in as little as nine to 11 weeks. After all, a maintenance appointment after four quads of SRP should be a breeze, right? Supplement. D4910 Periodontal Maintenance D9430 Office Visit for Observation (during regularly scheduled hours, no other services performed) D9910 Application of Desensitizing Medicament Form NY81175B1 IC(10/06) Refer to the policy for complete details, limitations, and exclusions. Treatment type: Maintenance Patient. Periodontal diseaseâliterally, disease âaround the toothâ - affects the gums and the bone to which a tooth is attached. We know this is an issue, but do not know where to start. Helping our patients who have cancer includes being supportive as we help them take care of their oral health while they transition through cancer therapy. If his/her current insurance company covered the provided therapy, it may be easily proven. They simply know that one code has a much higher fee than the other. © YYYY Colgate-Palmolive Company. D4910 Perio Maintenance Full Mouth Probe Intraoral photos D9630 Perio Gel Trays 1-2x/day for 15 minutes* * Patients with severe periodontitis may need to continue 2x/day in maintenance. Now, everyone knows that each patient varies and so do circumstances in the schedule from day to day. Ex: SPR done on (mm/dd/yyyy) at UR and LR. Periodontal maintenance CDT D4910 Category : PERIODONTICS Periodontics is the specialty of dentistry that encompasses the prevention, diagnosis, and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function, and aesthetics of these structures and tissues. D1110 consists of the removal of plaque, calculus and stains from thetooth structures. Full-mouth probing to identify target areas of inflammation, pocket depth, and calculus accumulation is imperative. D4910 is a dental code that can cause confusion.
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