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
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.