Content Dam Diq Online Articles 2015 11 Kyle S Coding 1

Dental coding with Kyle: D1110–Prophylaxis vs. D4910–Periodontal maintenance

July 18, 2016
As though figuring out propoer dental coding isn't hard enough, it's constantly changing. The dental coding with Kyle column is designed to help the dental team clarify those confusing codes and keep up with any changes.
Has dental coding got you confused? It has a way of doing that. No one wants their practice to miss proper payment due to improper coding. This article is designed to help you understand when to use D110 and when to use D4910.

Let’s start by reviewing what defines an adult prophylaxis visit
According to the CDT descriptor, an adult prophylaxis consists of removal of plaque, calculus, and stains from tooth structures in the permanent and transitional dentition. It is intended to control local irritation factors.

Now let’s dissect the long description and break it down into what matters

When is it appropriate to bill D1110–Prophylaxis adult?
If you are a general dentist (GP)
If your patient has no signs of periodontitis or deep pockets
If your patient is 14 years of age or older (some plans will consider age 16). Be sure to check age limitations and exclusions with the patient’s insurance carrier.
If your patient does not require a D4355–full mouth debridement
If your patient has not undergone any type of periodontal therapy, such as scaling and root planing, osseous surgery, or ongoing periodontal maintenance visits
If your patient is completely endentulous and has upper and/or lower dentures. (Be sure to include a narrative explaining that your patient has dentures.)

Examinations should always be billed separately.

Now let’s review what defines a periodontal maintenance visit
According to the CDT descriptor, a periodontal maintenance visit is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of bacterial plaque and calculus from supragingival and subgingival regions, site-specific scaling and root planing where indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.

Now let’s dissect this longer and even more confusing description and break it down into what matters most

When is it appropriate to bill D4910–periodontal maintenance?
If the dentist is a periodontal specialist (periodontist)
If your patient is currently being maintained for a history of periodontal disease
If your patient has undergone a full mouth debridement and requires therapy to maintain healthy gums in order to slow progression of periodontal disease
If your patient has undergone periodontal scaling and root planing within the last 24 months
If your patient has undergone periodontal osseous surgery within the last 24 months
If your patient has a history of periodontal gingival flap surgery

Be sure to bill periodontal examinations separately.

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Kyle L. Summerford is CEO and founder of Summerford Solutions, Inc. and editorial director of PennWell’s Dental Assisting & Office Manager Digest e-newsletter. He provides professional business coaching for dentists. Mr. Summerford is a professional speaker and author focusing on topics such as increasing practice revenue and staff efficiency training. Visit with inquiries regarding his dental practice efficiency services.