Carol Tekavec, RDH
The American Academy of Periodontology hosted the International Work shop for a Classification of Periodontal Diseases and Conditions in the fall of 1999. One of the purposes of this workshop was to revise the perio-classification system that had been published subsequent to the 1989 World Workshop in Clinical Periodontics.
The 1989 classification system was updated to reflect current thinking in the area of periodontal disease and its various components. As a result, two new manuals with the updated information - the Current Procedural Terminology for Periodontics and Insurance Reporting Manual - Eighth Edition and the Annals of Periodontology - were recently released by the AAP.
What was previously referred to as the "Diagnosis and Classification of Periodontal Diseases" now is called the "Classification System for Perio dontal Diseases and Conditions." The use of both a "diagnosis" and a "case type" when classifying periodontal conditions has been replaced by the use of a diagnostic classification that can be modified by "indications of the extent and severity" of the condition.
"Disease Classifications," as previously defined by the AAP, have referred to the etiology, pathogenesis, and host factors involved with periodontal disease. "Case Type" referred to a description of disease progression and severity. Now classifications will refer to the complete diagnosis of a condition, which should include the extent and severity of the disease. Extent is to be characterized as Localized, when 30 percent or less of sites are involved; and Generalized, when more than 30 percent of sites are involved. Severity is to be based on the amount of clinical attachment lost: Slight = 1 or 2 mm; Moderate = 3 or 4 mm; and Severe = 5 mm or more. (Remember that "clinical attachment loss" typically can be thought of as recession and pocket depth combined. A tooth demonstrating 2 mm of recession and 4 mm pockets actually has a 6 mm "clinical attachment loss.") So, a patient presenting with conditions that had previously fallen under the category of a Case Type III, Mod erate Periodontitis, might now be classified as Aggressive Perio dontistis; Extent - Generalized; Severity - Severe.
At some future date - if and when the ADA SNODENT (Synchronized Nomenclature of Dentistry) code numbers are put into effect - each of the AAP diagnoses listed in the "Classification of Periodontal Diseases and Conditions" in the Current Procedural Terminology for Perio dontics and Insurance Reporting Manual - Eighth Edition could be given a number for claim reporting. What would this mean for offices reporting periodontal treatment now?
Despite the fact that "Case Types" have been eliminated in the new AAP system, their use still will be needed for some time to come when reporting treatment to third parties. Most insurance carriers base benefits on insurance-industry parameters re gard ing extent and severity of disease through case types. For example, most carriers will not provide a patient benefit for a D-4341, Periodontal Scaling and Root Planing, unless the patient is minimally described as a Case Type III - Moderate Periodontitis, with bone loss and probing depths of over 5 mm on the teeth requiring treatment. Five involved teeth typically are required for a full-quadrant benefit, with partial benefits provided for 4/5 of a quad for four teeth, 3/5 of a quad for three teeth, etc.
The dental-insurance industry bases its parameters on what is accepted by the profession. However, acceptance of change is notoriously slow. While it is important for dental offices to be apprised of new developments, insurance carriers probably still will look for a written diagnosis and a case type. Updated terminology, such as chronic periodontitis rather than adult periodontitis, can be used on claim forms along with the "Case Types," for the present.
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.steppingstonetosuccess.com.