Localized SRP 1-3 Per Quad

We are dealing with the aftermath of a hygienist who "prophied" patients with localized early perio disease every 6 mos for years. Most often we are seeing people with localized 4-5 mm probes with bleeding affecting 2-3 teeth per quadrant. When we inform the patient of their periodontal disease it is generally at an appointment where they were expecting another "prophy". We are trying to educate our patients and give them the best treatment without "scaring" them away. Is it appropriate the do a prophy and bill it as such to the insurance at this visit while educating the patient about why they need to return for an appointment with localized SRP, and then schedule the SRP for asap? I was told that we could not bill a prophy "in the presence of disease", but what if the bone loss is restricted to 1-3 areas per quadrant and the patient will return for localized SRP? We do have the patient return for a 4-6 week re-eval and could clean areas without bone loss at this time, but I like to do that first while educating the patient but worry about inappropriately billing a patient with perio as a prophy and my office manager worries about frequency limits if we do a prophy before localized SRP and then bill again for prophy or perio maintenance at 4-6 week re-eval. We follow the re-eval with a 3-4 month periodontal maintence visit.
1 Answers
From what you are describing, these are patients that present with both mostly healthy areas of their mouth but with localized areas of active infection. From a clinical perspective; the patient needs BOTH preventive and periodontal treatment; however, whether you bill those separately or not is up to your practice. In some cases a practice would diagnose and bill for the localized periodontitis and simply include a prophylaxis with that treatment at no additional charge. In other cases, and the way I would approach it, the patient would have a diagnosis for localized periodontitis on the day they were scheduled for their "regular" prophylaxis, and the dental hygienist would initially provide the preventive care (prophy) on healthy sites ONLY; then the patient would be treatment planned to return for localized active therapy. To me, the advantage of this approach is that it helps to draw clear distinctions between preventive and therapeutic care. They are not the same - even though in many practices they have both been provided under the description of "Adult Prophylaxis". When a history of prophylaxis have not resolved area of localized perioontitis; clearly the patient requires more definitive therapy.
They need:
- A clear diagnosis,
- Agreement that they wish to proceed with necessarytherapeutic treatment, and
- Closely-monitored follow-up to insure the disease is under control.
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