D4341: Periodontal scaling and root planing (SCRP) four or more teeth, per quad
D4342: Periodontal scaling and root planing (SCRP) one to three teeth, per quad
To facilitate dental claim approval, you must make sure your patient meets the insurance plan guidelines prior to performing the treatment and when submitting the dental claim for reimbursement.
More Coding with Kyle:
- Coding with Kyle: D7960—Frenectomy
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- Coding with Kyle: Overdenture coding after implant placement
SCRP involves the removal of plaque and calculus from the root surfaces of the teeth usually under local anesthesia. It's not the same as a full-mouth debridement (D4355) or prophylaxis (D1110).
Here are some key factors that facilitate insurance claim approval:
- Pocket depths greater than four millimeters
- Supporting documentation with narrative indicating periodontal disease and classification type
- Periodontal charting indicating loss of attachment/bone loss, bleeding on probing, and pocket depths of 4mm or more
- The same procedure(s) have not been completed within the last 24 months for most dental PPO plans, when billed to the same dental plan
- Most dental plans prefer SCRP be completed in two separate visits under local anesthesia (indicate)
- If SCRP was completed in a one visit/one hour appointment, be sure to indicate why and submit a narrative outlining the reason (e.g., patient tolerance)
- Radiographs showing bone loss
When submitting the dental claim to your patient’s insurance company, be sure you submit the claim with supportive documentation which indicates the necessity. Proper documentation includes notes in the patient's chart, including periodontal charting (within six months), and a clear indication if any presence of calculus, bleeding on probing, and bone loss. Be sure to include the patient's most recent x-rays (preferably a full-mouth series).
Always keep in mind that it's recommended to send in a pretreatment authorization including radiographs and periodontal charting to ensure a smooth claim determination process.