September Coding Facebook Fallacy- You Can Win!

This month’s FB Fallacy, we are going to look at a conversation that shows exactly why coding education is needed. Note: DentalCodeology recognizes that no one is intentionally sharing misinformation. At the end, I will share my POV (point of view). AND You have the opportunity to win a book by submitting your treatment plan and coding thoughts.

FB question: Curious which codes & charges are used for your patients’ 4-6 week post-srp eval visit.

  • FB Response 1: D4999 unspecified….I use as post SRP evaluation. No charge. Evaluate what they are doing, how things are looking and then reappoint 3, 4 or 6mos maintenance from last SRP appointment.
  • FB Response 2: I thought it was…0150 initial exam, 4341/4342–srps,. 0180–6-8 week evaluation and then 4910 3 months after for their first perio maintenance🤔
  • FB response 3: Exactly. 180 if PERIO & plan to SRP, 150 if regular Prophy. When you use 180 as initial due to PERIO you can run report to always track your PERIO pts.
  • FB response 4: LADIES , if a patient is truly PERIO when they return in 6,8 or 12 weeks or 3,4 mth recare however your offc does YOU should not be using Prophy! NOT! It will be 4910 PERIO Mtn .
  • FB response 5: Unless you did FMD 4355 or 4346 gingivitis / inflammation

Patti POV: OMG-what these ‘experts’ are sharing is based on anecdotal experience versus any knowledge of codes. What is missing first and foremost in this discussion is diagnosis. All coding should be based on medical necessity which includes a diagnosis and risk assessment. Codes don’t follow an artificial sequence, they should follow a diagnostic sequence. A related concern is what reads as all perio is the same. Let me step back a moment to clear up some confusion on terms. For many, perio means bone loss, that is not exactly correct.
The term periodontium is the supporting structures of the teeth. Someone with gingivitis is a perio patient. The reason for this emphasis is health and disease are on a continuum. Sequencing of treatment depends on the diagnosis and as well as where the person has been treated on the continuum AND if we have a record of it.

Case History-You Can Win!!
Kelly is a patient of record. As a matter of fact, you are the only RDH she has ever seen. Her 20 year history in your practice has been for prophylaxis only. When she returns a couple months late for her routine 6-month appointment, life significantly changed. She tells you, she has:

  • cold sensitivity lower both side
  • bleeding especially upper left
  • GERD but that could be because she thinks she maybe pregnant

Kelly is exhibiting the signs of perio making the accurate code make a diagnosis are:

  • D0180 comprehensive periodontal evaluation
  • D0277 seven vertical bite-wings (a pano was taken before she went away to college)

Her presenting oral conditions:

  • Her perio chart shows several areas of 4mm pockets with moderate inflammation.
  • Radiographic images show between #14-15 there is a 6mm defect with 4mm pocket and 2mm bone loss

Your Turn:
So what is your overall plan including sequencing and codes? Hint: Need to be individualized based on Kelly’s total health presentation.

The first 5 responses posted here win a copy to CDT Shifts book that includes updated flow charts with the 2018 AAP Classifications.

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11 Comments. Leave new

  • Confirm if Kelly is pregnant by referring her to her PCP for a pregnancy test. What code is that?
    Determine if Kelly is bruxing
    Scaling in the presence of inflammation 4346
    2-3 weeks later 0180 followed by a prophy 1110 and or localized SRP for upper right 4342 followed by perio maintenance 4910 3 weeks later. Future treatment to be determined at this appointment based on over all health profile

    Reply
  • Confirm if Kelly is pregnant by referring her to her PCP for a pregnancy test. What code is that?
    Determine if Kelly is bruxing
    Scaling in the presence of inflammation 4346
    2-3 weeks later 0180 followed by a prophy 1110 and or localized SRP for upper right 4342 followed by perio maintenance 4910 3 weeks later. Future treatment to be determined at this appointment based on over all health profile

    Reply
    • Great question, there is a code D9992 dental case management – care coordination that could be used for the referral to PCP. Good call on bruxing. I think you might be ‘pre’-diagnosing to decide if a D1110 is appropriate in 2-3 weeks. What I am not reading is a diagnosis/classification?

      Reply
  • Since Kelly has bone loss, I would not use the gingivitis code! I don’t have enough information to prescribe treatment for more than the UL which would be D4342. The rest of the mouth would either need D1110 or additional D4342 if there is bone loss in those quads as well. Assuming Kelly is pregnant, I would ask her back in 6 weeks for either D4910 or D1110 if only the UL was Perio involved. In addition I would perform a clinical laboratory test to determine what bacteria caused such a dramatic shift in her health. I would also prescribe a homeopathic mouth rinse and gel. Doctor exam to determine reason for sensitivity.

    Reply
    • Ah an reply from an expert! Glad to hear from you Kim. Could her treatment be sequenced to perform D4346 that day and because is that level of infection to return to re-evaluate and perform D4342 on the UL? Is that best plan? Losing 2mm of bone in 8 months is certainly worrisome. Perhaps the best plan is no scaling without more investigation as to her pregnancy state and pathogen testing as you say. There is so so much to this case. What you see as is the point that this case is not simple.

      Reply
  • Would you use a different code for seven vertical bitewings, 0277?

    Reply
  • 4342 SRP quad 2 and 4346 gingivitis scaling all other sextants.

    Reply
    • What is the diagnosis/classification for this plan? What is the sequence? What about her other health risk factors? What two quads are you treating with D4342?

      Please contact me at Patti@DentalCodeology.com with mailing address so I can send you the book you won!

      Reply
  • After full periodontal charting is completed, complete updated medical history, review any nutritional changes and under doctors diagnosis I would perform scaling under inflammation for today’s visit with placement of varnish 1206 on all 4 quadrants followed by 4342 SRP ULQ appt.

    Reply
    • What is the code for scaling under ginginval inflammation? What is the appointment sequence? What is the diagnosis/classification? What is the follow up plan?

      Reply

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