Periodontal codes in the procedure mix

Oct. 14, 2014
I have two very good, seasoned, full-time hygienists. They are both hard workers, and my patients seem to love them.

BY Dianne Glasscoe Watterson, MBA

Dear Dianne,

I have two very good, seasoned, full-time hygienists. They are both hard workers, and my patients seem to love them. Both hygienists have been working with me for 10 years. Recently, I ran the report that shows the breakdown of procedure codes by provider. What I found was that the periodontal codes occupy only about 3% of my total hygiene procedures. From what I've read, this seems very low. I read somewhere that periodontal codes should be about 33% of all hygiene procedures. My question to you is, how do I get my hygiene department more attuned to periodontal care and off the prophy treadmill?
- Dr. Dan

Dear Dr. Dan,

Indeed, 3% of total hygiene procedures is very low. There are a number of reasons that could explain why this is occurring in your practice.

1. Hygienists are not regularly performing full-mouth, six-point, periodontal charting and recording for all adult patients. It could be that they are scheduled so tightly that there is insufficient time, or maybe there is no one to help them get the charting recorded. It takes about 12 to 15 minutes for a solo hygienist to do a thorough probing and recording, whereas with the aid of an assistant helping with recording, it takes less than five minutes. If this is the problem, make your hygienists aware that you want every adult patient to have a periodontal charting/recording once per year. It is essential that you proactively remove any barriers by providing an assistant to help with charting procedures or investing in a voice system that efficiently records the readings.

2. Low numbers of new patients, which stagnates growth. A healthy stream of new patients keeps the practice "circulation" healthy and provides opportunities for restorative and periodontal procedures. Many practices today have large numbers of established patients that are well-maintained and few new patients. In such practices, the 33% metric is not applicable.

3. Lack of a written periodontal protocol. A well-written periodontal treatment protocol that outlines specific treatment plans for patients based on severity is an excellent way to clarify treatment and provide the roadmap for care.

4. Hygienists do not have their periodontal "radar" engaged. One of my mantras is this: if you're not looking for it, you probably won't find it. Just like dentists, hygienists sometimes settle into a comfort zone. They may become accustomed to dismissing bleeding or inflammation as "normal" for certain patients.

5. Hygienists may not be equipped with the proper verbal skills to help patients understand their periodontal issues. They may lack communication skills to enter into a discovery with the patient, and then usher the patient into a commitment for definitive care.

6. Hygienists may not be aware of certain codes, such as D4342, root planing and scaling one to three teeth. It is not unusual to find this code completely missing in the procedure mix report. Yet many established patients have early periodontal problems and could benefit from site-specific, definitive care.

Of the aforementioned reasons, the first two require action on your part. Specifically, you must remove any barriers that prevent your hygienists from performing comprehensive periodontal chartings. You may also need to implement a plan to increase your new patient numbers by ramping up your marketing or even engaging in limited PPO participation.

For the last four reasons, an outside third party would be beneficial for your practice. A qualified hygiene consultant can analyze the hygiene department data, develop a "treatment plan," and provide a written protocol with the necessary, individualized training for your hygienists.

A thriving, productive hygiene department is a sign of a thriving, productive practice. Commit to doing whatever is necessary to keep your patients periodontally healthy and your business in a growth pattern.

All the best,

Dianne Glasscoe Watterson, MBA, is a consultant, speaker, and author. She helps good practices become better through practical on-site consulting. Her book, "Manage Your Practice Well," is available at For consulting or speaking inquiries, contact Dianne at [email protected] or call her at (301) 874-5240.

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