by Carol Tekavec, RDH
In the current and active ADA coding book, CDT-3/2000, Code D4910, "Periodontal Maintenance Procedures (Following Active Therapy)" received a revised description. The description currently reads, "This procedure is for patients who have completed periodontal treatment (surgical and/or non-surgical periodontal therapies, exclusive of D4355) and includes removal of the bacterial flora from crevicular and pocket areas, scaling and polishing of the teeth, periodontal evaluation, and a review of the patient's plaque control efficiency.
"Typically, an interval of three months between appointments results in an effective treatment schedule, but this can vary depending upon the clinical judgment of the dentist. When new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered. Periodic maintenance treatment following periodontal therapy is not synonymous with a prophylaxis."
Changes from the CDT-2 version include:
- The word "nonsurgical" replaces the word "adjunctive."
- A "periodontal evaluation" is now included as part of the procedure.
While it was expected that the ADA would change D4910 in the year 2000 to include a periodic oral evaluation (recall exam), this did not happen. Instead, a periodontal evaluation was added. A periodontal evaluation may imply a periodontal diagnosis, or it may be considered only one component of a total evaluation prior to a diagnosis. Greater clarification from the ADA is needed and will hopefully be included in the next CDT revision; possibly in 2005.
As it now stands, periodontal data collection may be delegated to a hygienist, if the state dental practice act approves these procedures. This data collection includes periodontal probing and documentation of bleeding, furcations, recessions, and mobility. Diagnosis of such data legally remains the responsibility of the dentist.
Since the CDT-3 description of D4910 does not include a periodic evaluation (recall exam), a D0120-Periodic Oral Evaluation may be properly reported with a separate fee, as well as any code or fee for radiographs. While the D0120 may be appropriately reported, it usually will not be covered by insurance.
Whatever the ADA description, insurance carriers typically cover D4910 by providing a benefit twice per year, following documented surgical treatment or root-planing, and excluding a separate benefit for an exam.
Carriers usually pay for two "cleanings" of any type per year and include a D4910 under that heading. They also usually pay for two "exams" of any type per year and include a D0120 under that heading. They usually will not pay for a D0120 charged out on the same day as a D4910.
In most cases, a benefit usually will not be allowed for Code D4910 unless it is performed at least three months following active therapy (either periodontal surgery or for D4341, Periodontal Scaling and Root-Planing). A few carriers downcode payment to what they allow for a D1110, Prophylaxis-Adult.
When submitting claims for payment of a D4910, include the following information:
1. Periodontal case type: The American Academy of Periodontology has changed reporting from case types to the 1999 "Classification for Periodontal Diseases and Conditions." However, insurance carriers are expected to continue to use "case types" for the near future.
2. Dates of root planing or surgery
3. Complete, progressive periodontal probing depths, bleeding points, recession, furcations, and mobility. (For a complimentary sample of a charting form for all of these indicators and six successive appointments, as well as a medical/dental history, call 800-548-2164.)
4. Assessment of home-care effectiveness (poor, adequate, good)
Code D4910 is an important and usually adequately paid code describing periodontal maintenance. Patients who require D4910 follow-up care should receive as many per year as advised for appropriate treatment, regardless of insurance coverage. Services not covered by the patient's insurance should be paid for by the patient.
Carol Tekavec, RDH, is the author of a new insurance-coding manual, co-designer of a dental chart, and a national lecturer with the ADA Seminar Series. Contact her at (800) 548-2164 or visit her Web site at www.steppingstonestosuccess.com.