Insurance Records, Risk and Reimbursement

Many problems that occur over and over in dental offices fall into the categories of "Records, Risk and Reimbursement." This column will focus on records and reimbursement for a periodontal screening.

Carol Tekavec

Many problems that occur over and over in dental offices fall into the categories of "Records, Risk and Reimbursement." This column will focus on records and reimbursement for a periodontal screening.

A periodontal screening differs from a comprehensive periodontal evaluation in both scope and data collected. The latest screening technique is the Periodontal Screening and Recording, or PSR™, developed by the ADA and the AAP with the sponsorship of Procter and Gamble. This screening system was adapted from the Community Periodontal Index of Treatment Needs or CPITN, developed by the World Health Organization to identify patients with periodontal disease.

The screening is performed by dividing the mouth into sextants and "walking" a perio probe, with a .5 mm ball tip and a darkened band from 3.5-5.5 mm, around each tooth or implant. A single evaluation number or "code" is given to each sextant, as opposed to the six recordings per tooth required for a comprehensive perio evaluation. One of five possible codes (0, 1, 2, 3, 4) is assigned to each sextant, according to three criteria: probe-reading (visibility of the darkened band), bleeding on probing and calculus or other irritant, such as an overhanging margin present.

Recordkeeping for a periodontal screening is very simple. Each screening results in the recording of only six numbers, plus any pertinent notations as to any special problems seen in each sextant. The scores may be entered on a regular chart form, preferably one that has space for multiple visits, on pressure-sensitive labels with the six necessary rectangles preprinted or simply recorded in the patient`s progress notes.

A periodontal screening can be performed at a patient`s initial oral examination, and if the codes in all sextants are "0, 1, 2," then subsequent exams may include screenings only. If the periodontal screening reveals codes "3, 4" in any sextant, then subsequent patient exams should include comprehensive periodontal probing.

Offices that perform a comprehensive periodontal probing on all initial visits must set aside sufficient time for recording all data. Offices that perform a periodontal screening at a patient`s initial exam probably will need to set up a subsequent appointment for comprehensive data collection and recording. (For example: collection of data and documentation with the hygienist for 20-30 minutes, followed by an additional 10 minutes with the dentist for a final diagnosis.)

There is no treatment code that applies to a periodontal screening or a comprehensive periodontal probing. Both are considered to be part of a clinical oral evaluation (Code 00120-Periodontic Oral Evaluation, Code 00140-Limited Oral Evaluation, Code 00150-Comprehensive Oral Evaluation or Code 00160-Detailed and Extensive Oral Evaluation-Prob-lem-Focused, By Report).

Carol D. Tekavec, CDA, RDH, is an author, lecturer and owner of the consulting firm, Stepping Stones to Success, in Pueblo, CO. Contact her at 800-548-2164.

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