Comprehensive periodontal therapy

Diagnostic Casts + Occlusion Analysis + Occlusal Adjustment = Comprehensive Periodontal Therapy

Tom Limoli Jr.

Diagnostic Casts + Occlusion Analysis + Occlusal Adjustment = Comprehensive Periodontal Therapy

Here's how this formula works:

The codes

D0470 — diagnostic casts
D9950 — occlusal analysis–mounted case
D9951— occlusal adjustment–limited
D9952 — occlusal adjustment–complete

The casts

Study models are payable as a diagnostic service intended for the documentation and subsequent analysis of occlusion. The casts are most often a reimbursable benefit once per case in conjunction with an orthodontic-treatment plan. Additional casts taken during or at the conclusion of an orthodontic treatment plan are not individually reimbursable by the plan and are not identified separately. Only the "base-line model" is identified, because the fees for all subsequent casts are usually included in the global fee for the completed treatment plan. Excluding orthodontics, benefit plans rarely, if ever, reimburse for study models. Some of the more current, well-funded benefit plans address reimbursement for diagnostic casts with a 60-month exclusionary period.

Do not separately identify and/or bill for diagnostic casts if you are fabricating a bleaching tray, mouth guard, or any other type of appliance or splint. With any type of appliance fabrication, the "working models" are considered part of the construction process and are not separately identified. Diagnostic casts are for diagnostic purposes.

In addition to orthodontic documentation, some examples of clinically significant diagnostic casts are:

• Assessment needed regarding possible fixed or removable prosthetic
• Documentation of gingival-attachment levels, whether they are rolled or knife-edged tissue margins
• Nonfunctioning teeth and other issues of traumatic, occlusal discrepancy

With these and other clinical conditions, more detailed occlusion analysis and possible adjustment procedures may be necessary.

Now we add the analysis

Occlusion analysis is the study of the relations of the occlusal surfaces of opposing teeth and their associated functional harmonies. The primary purpose of occlusion analysis is to reveal interferences in articulation that cannot be observed directly in the mouth.

Once the simple diagnostic casts are transferred to an adjustable articulator via a face bow and bite fork, we begin to encompass the definition of procedure code D9950 — occlusion analysis. This detailed analysis is performed prior to the initiation of any comprehensive restorative, prosthetic, or periodontal-treatment plan. The analysis will identify the corrective measures that are necessary to harmoniously balance the functional dynamics of occlusion.

Adjustments improve function

Occlusal adjustment is the scientific grinding and/or reshaping of the occluding surfaces of teeth to develop and improve upon their harmonious relationships between each other, their supporting structures, muscles of mastication, and temporomandibular joints.

This procedure is reported as either being limited (in scope) or complete. These descriptors should not be confused or correlated with either per tooth, by quadrant, or full-mouth. The descriptors do not equate.

Occlusal adjustment-limited: This usually identifies a single-visit procedure that addresses only a specific tooth, site, or quadrant. Discing, odontoplasty, and enamoplasty usually are single visit procedures.

Occlusal adjustment–complete: A multi-visit series of treatments that would include the teeth, the neuromuscular mechanisms of chewing, and/or a combination of both.

Fees and what to charge

Remember that the fee for occlusal adjustment is separate and does not encompass the fee for the diagnostic casts and analysis. All three are identified and billed separately.

When all is said and done, it's the patient — not his or her benefit plan — that is responsible to your office for the total cost of dental treatment.

Tom Limoli Jr. is the president of Atlanta Dental Consultants and the editor of Dental Insurance Today, a bimonthly publication that addresses third-party reimbursement in the dental office. He also is the author of Dental Insurance and Reimbursement Coding and Claim Submission. He can be contacted by phone at (404) 252-7808. Visit his Web site at www.LIMOLI.com.

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