POWERED BY THE DENTISTRY NETWORK

Coach's Corner for Dental Coding: Alternating D1110 and D4910

Q: I’m in a new office and they alternate D1110 and D4910 after periodontal treatment. I know this is wrong, so how do I make the case to my doctor to change this bad habit?  - Anonymous

A: This comes up in my presentations so often that I’ve built a discussion point around it. Unfortunately there is so much bad information out there regarding how to bill these two procedures. D1110 is a prophylaxis (in the absence of gum disease) and D4910 is a periodontal maintenance procedure (in the presence of a disease state – active or maintained). Managers have told me that they have been told to alternate the codes by:

· Referral offices that believe they should bill D4910 and the general dentistry office should bill D1110 when sharing care of a periodontal patient.
· Insurance company representatives.
· Doctors/coworkers who have never taken a coding course.

You are correct in that it is wrong to alternate between the codes. D1110 is meant for healthy tissue. D4910 is meant to be used after periodontal treatment such as scaling/root planing or osseous surgery. It is meant to describe a more in-depth procedure than a prophylaxis in the presence of a disease state. Hopefully this disease state is not progressing because you are monitoring it, but it certainly is different than normal healthy tissue found in persons with no gum disease.

Simply put, to alternate the codes means you are stating that the patient is healthy, diseased, healthy, diseased, etc. I also want to be clear that this is fraudulent billing. If you are alternating codes because you believe that better reimbursement will follow, then you are committing fraud. Your codes should always reflect the service you provided, not the reimbursement you expect.

When presenting periodontal treatment to a patient, be sure to disclose that D4910 is what he or she will undergo in lieu of the traditional prophylaxis. Explain why (their mouth is not as healthy as it used to be), and be clear about the financial impact. Insurance plans sometimes cover D4910 up to four times a year at the basic level after deductible. Some plans will cover D4910 at the preventive level with no deductible up to three or four times a year. Be sure to check the patient’s benefits before you quote them a copayment amount. Remember to stress that this is a long-term change to their dental care.

RELATED VIDEO: Kevin Henry talks to Teresa Duncan about what's new with the American Association of Dental Office Managers (AADOM)

RELATED ARTICLE: Coach's Corner for Dental Coding: Focusing on COBRA

Teresa Duncan, MS, FADIA, FAADOM, is an international speaker who addresses topics such as insurance coding, office manager training, and revenue growth. Her company, Odyssey Management, Inc., provides virtual, customized training in these areas. She can be reached at Teresa@OdysseyMgmt.com.

Editor's Note: The dental procedures codes ("Code") are owned and published by the American Dental Association ("ADA") in its reference manual Current Dental Terminology ("CDT"). The ADA is the exclusive owner and copyright holder of the CDT, including the Code, as well as of the ADA claim form.

Related Articles

Advice for dentists – Negotiating with insurance companies

Amanda Weber, MHA 12/29/2014

We all have to stay in the game of dentistry by accepting one, or in most cases, all of the PPO insurance providers. This author explains that it doesn't hurt to ask the insurance companies about their reimbursement plans.

Thursday Troubleshooter: Practice accepts Blue Cross; does it still need to opt into Medicare?

12/11/2014

Questions abound regarding dental offices and opting in our opting out of Medicare. Does this office need to opt in if they accept
Medicare Plus Blue and BCN Advantage?

VIDEO: Proven tips regarding insurance management for dental practices

11/25/2014

Insurance can be a pain in the side of any dental practice. In this video, Cathy Jameson explains that having the proper procedures in place can help immensely.

Dental insurance most popular benefit option for Colorado small businesses

DentistryIQ Editors 11/20/2014

Half of Colorado’s smallest businesses are considering changing health insurance carriers for 2015 and dental insurance is the most important option to these businesses, according to results of a recent statewide survey of small businesses commissioned by Delta Dental of Colorado.

Stay Connected

Subscribe to Dentistty IQ's Newsletters

Dental Photo of the Day

There is no current content available.