George E. Valentine, DDS, MS
At the conclusion of an otherwise excellent piece on scaling and root-planing (February Dental Economics), Carol Tekavec misinforms readers concerning the procedure and subsequent coding of D4355-Full Mouth Debridement to Enable Compre-hensive Periodontal Evaluation and Diagnosis. It is well-defined in CDT-3/2000 and is, in fact, appropriate care in certain circumstances.
It has long been the position of some major insurers with managed care plans to deny this procedure for fear of abuse by substitution for prophylaxis. We have never seen accurate studies confirming this abuse pattern and consider that particular thinking anecdotal and unscientific.
Realistically in many cases, dentists cannot determine pocket depths and the true extent of periodontal disease without removal of subgingival calculus. Adding to the conundrum is the plain fact that we cannot even prescribe prophylaxis without completing proper examination and diagnosis. The PSR technique, in combination with a comprehensive oral evaluation (Code D0150) allows a screening methodology to proceed with more definitive data collection and disease determination. Final pocket depths are determined after the gross subgingival scaling and the proper treatment plan is formulated.
I do not believe we would have defined and documented this procedure with its code if it were not "viable" or a "standard of care." It is necessary and appropriate and can easily be validated with radiographs, intraoral pictures, and subsequent charting.