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Altering a Patients Coding Without Charging for SRP 1st?

Ask the Expert ForumCategory: Insurance CodingAltering a Patients Coding Without Charging for SRP 1st?
guestuser asked 10 years ago
Hello, I'm a fairly new RDH and have been in a general practice for a year now. We have 3,4, and 6 month recalls, all coded as D1110. I would say about 40% have some sort of perio whether it be localized or generalized, and almost all have insurance. Some of these patients have had 4mm+ probe readings since their initial exams which we code as D0150, and the others have become periodontally involved over years. My question is, can we change a patient that we have been coding D1110 to a a D4190 perio maintenance without charging for SRP 1st, and will insurance pay for it? Coding correctly is something that I have a great interest in, but I don't have the knowledge. Also, do you know of a coding CE class? Thanks in advance, Hillary
1 Answers
Karen Davis, RDH, BSDH answered 5 years ago
A great resource worth investing in is “Coding with Confidence” by Charles Blair. You can view a sample of it at: I have used this reference for years to assist in maximizing patient’s benefits. The situation you refer to in your practice is not necessarily uncommon. Decreasing a patient’s interval may be helpful in reducing the amount of biofilm and local factors present in the oral environment, but is no substitute for an accurate diagnosis and therapeutic intervention. The answer to your question is: No you cannot move from D1110 to D4910 without first making a diagnosis and providing appropriate definitive therapy. The ADA definition of periodontal maintenance states that is begins “following periodontal therapy." There is no appropriate way to bill out D4910 without prior scaling and root planing or osseous surgery. From your description, it sounds like these patients with 4mm+ should be accurately assessed for active periodontal infection, and when present, be treated with nonsurgical and/or surgical treatment, as indicated. Following that protocol, D4910-Periodontal Maintenance would be indicated. It is great that you are concerned enough to want to provide appropriately billed procedures. Best to you. KAREN DAVIS, RDH, BSDH

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