Periodontal Charting Code

[Kemal Allan]

Iunderstand these codes and insurance should not in any way dictate treatment recommendations; however, understanding these codes and their limitations helps to have conversations with patients regarding the recommended treatment. I do want to preface this article with a clear call to action to never let insurance coverage dictate what treatment you provide or recommend.

With that said, I want to review some CDT codes that you are likely not utilizing that may help your patients in the event their insurance covers the procedure. Even if the procedure is not covered, we should report what we do to the insurance company.

Many of you may be familiar with this code and currently use it. However, in my experience, this is a very underutilized code that should be used more often. This code cannot be used in conjunction with other oral evaluation codes such as D0150 (comprehensive evaluation) and D0120 (periodic oral evaluation).

This code can be reported by general dentists; it is not exclusive to periodontists, which some dental professionals assume. The criteria to use this code is that the patient presents with signs, symptoms, and/or risk factors for periodontal disease: patients with a family or personal history of periodontal disease, type 2 diabetes, cardiovascular disease, hypertension, rheumatoid arthritis, smokers, etc.

As you have a conversation with your patient regarding their care and the reimbursement they can expect from their insurance company, it is good information to have. This code can be reported on the same service date as periodontal maintenance therapy (D4910), prophy (D1110), and D4341/D4342 (periodontal scaling). D0180 cannot be billed at the same time as D4355 (full mouth debridement) as the very purpose of a full mouth debridement is to remove debris that prevents a comprehensive exam. In some cases, the insurance company may down-code the D0180 to reimburse for a D0120 (periodic oral evaluation).

This code can be utilized when patients return after nonsurgical periodontal therapy, four to six weeks for postoperative re-evaluation. Many hygienists like to follow up after nonsurgical periodontal therapy (NSPT) with a four to six-week re-evaluation; this is the code to use for that visit. This is also a code that could be used for follow-up after D4346 (scaling in the presence of gingival inflammation) if you would like to do a re-evaluation.2

Limitations regarding this code are that if insurance reimburses for D0171, it will likely count towards the frequency of other oral evaluations. This will likely mean that your patient will be responsible for their periodic oral evaluation (D0120) at some point during that year if the frequency is limited to twice a year.

The CDT code D1354 is most popular for the application of silver diamine fluoride. However, there are other medicaments that can be used that are included in this code description. You can also utilize this code when placing fluoride disks interproximally as a preventative for incipient interproximal lesions.

This code is used per tooth and for areas determined to be high risk for caries development, such as exposed root surfaces. Since fluoride of all types is excluded when using this code (gels, foams, and varnishes), the proper choice of medicament would be silver diamine fluoride, silver nitrate, thymol-CHX varnish, and/or topical povidone-iodine.

When deciding which code is most appropriate, consider the area you are concerned with. Is there an incipient or carious lesion? If the answer is yes, CDT code D1354 is most appropriate. Is the area of concern due to exposed root surfaces that have yet to have any carious lesion? In that case, the CDT code should be D1355. In short, if there is any type of carious lesion, the most appropriate code and treatment would fall under the D1354 code. If there is no lesion, but the area has an increased risk of one developing, the most appropriate code would be D1355.

The CDT code D9910 can be used for the application of fluoride varnish, use of TENS units to control pain, and pastes applied in-office designed for desensitization. This code is meant to encompass the entire mouth, as reported by visit.5

For instance, if you have a patient with generalized root sensitivity due to recession, this code would be an option to use for the application of fluoride varnish as a desensitizing agent. This could also be used post-whitening treatment for patients with sensitivity after treatment or generalized sensitivity due to attrition, abrasion, and/or erosion.

Reporting this code to the insurance company requires a narrative and/or descriptive documentation. Save yourself some time and headache and submit it initially rather than needing to appeal a claim due to not including proper documentation/narrative.

The CDT code D9911 is used for the application of desensitizing resins for cervical and/or root surfaces per tooth, not per visit. This means a tooth number will be required when reporting the procedure to the insurance company.6

There is a plethora of products that can be used with this code. The product simply needs to be a desensitizing resin. This does not mean it needs to be a composite resin, as that would be defined under a completely different CDT code. However, this would be an appropriate code to use when a desensitizing resin is placed adjacent to a class V composite resin because a patient is experiencing sensitivity.

This code is not meant to be used as a code for bases and liners under a composite resin. This code will also require a narrative or descriptive documentation that includes the tooth number and the reason for the application.

Understanding CDT codes can be a difficult task, especially when many hygienists have little experience, understanding, and/or education on the topic. However, a better understanding of the relevance and benefits of properly using CDT codes will benefit your patients and your practice. This is just a snippet of the codes hygienists can utilize to better serve their patients. I encourage you to take a CE course on CDT codes aimed at dental hygienists and not dentists, as the codes dentists would utilize are likely much different than those of hygienists.

We all know about D0150 Comprehensive Evaluation for New Patients. In certain instances, utilizing Code D0180 Comprehensive Periodontal Evaluation might be in your best interest.

This code came out initially for utilization by specialists. Both codes 0150 and 0180 are Comprehensive Oral Evaluations for new and established patients. The difference being 0180 is used exclusively for patients showing signs or symptoms of periodontal disease and with patients with risk factors, such as smoking or diabetes. D0180 requires complete periodontal charting, which includes, but is not necessarily limited to 6 points per tooth, probing, recording recession, furcations, bleeding points, mobility, attachment loss and a periodontal diagnosis. The 0150 may include a periodontal screening and list of any soft tissue anomalies but does not require any recording. That being said, many patients do meet this requirement both as new and/or re-establishing patients.

Most insurance carriers treat the 0180 similarly to the 0150 in that it counts towards one of the two exams that are typically paid per year, although some variations have been noted. Some carriers may reimburse D0180 every 12-24 months or every 3-5 years and some once in a lifetime. Some insurance carriers compensate at a higher rate for the D0180 vs. the 0150. So, this code can be helpful and is being used more and more by general practitioners.

Advanced Practice Management, including Bill Rossi, Shelly Ryan, Matt Lahn, Robyn Kain and Kelly Larson, helps dentists with overhead control, staff training, hygiene productivity, PPO participation decisions, dental marketing for new patients, associateships, and practice sale or acquisitions.

A periodontal charting and probing is necessary to make a diagnosis. D4355 is not intended to be a preliminary procedure prior to perio therapy, a common coding error seen. The intent is to perform a full mouth debridement to enable a comprehensive oral evaluation.

The hygienist performed a debridement of the supragingival plaque and calculus using an ultrasonic scaler. Oral hygiene homecare instructions were given, and chlorhexidine rinse was dispensed to the patient.

Remark code N402 indicates that the submitted claim has been flagged due to incomplete or invalid periodontal charting. This means that the documentation provided for periodontal services does not meet the required standards or is missing necessary information.

Ways to mitigate code N402 include ensuring that all periodontal charting is fully completed and accurately documented before submission. This involves double-checking that all necessary measurements, such as pocket depth, gum recession, and attachment loss, are clearly recorded. Training staff on the importance of detailed periodontal charting and regularly reviewing charting practices can also help prevent this issue. Utilizing electronic health records (EHR) systems that prompt for missing information can further reduce the risk of incomplete or invalid submissions.

The steps to address code N402 involve a multi-faceted approach to ensure complete and accurate periodontal charting. Initially, review the patient's dental records to identify any missing or incomplete periodontal charting information. Engage with the dental care team, specifically the dental hygienist or dentist who performed the examination, to clarify any ambiguities or to complete the charting if it was overlooked.

Next, ensure that all periodontal charting adheres to the current standards and guidelines, including depth measurements, bleeding on probing, suppuration, plaque levels, and any other relevant clinical indicators. If the charting was indeed incomplete or invalid, schedule a follow-up appointment with the patient to complete the necessary assessments.

3a8082e126