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Patient with Significant Calculus Build Up

Ask the Expert ForumCategory: Insurance CodingPatient with Significant Calculus Build Up
guestuser asked 11 years ago

If a patient has significant calculus build up at an initial appointment, is it worth getting a baseline for periodontal readings when they are obviously false until after a full mouth debridement?

1 Answers
Karen Davis, RDH, BSDH answered 6 years ago
The answer to this question requires clinical judgment. There are times when patients present with heavy deposits that actually do not interfere with the collection of diagnostic data and in that case periodontal data should be collected prior to preventive or therapeutic treatment, as indicated. However, there obviously are circumstances in which the clinician must literally “find the teeth” first in order to collect baseline diagnostic data by initially removing “gross” deposits. The ADA insurance procedure code for this preliminary debridement is D4355 Full Mouth Debridement To Enable Comprehensive Evaluation And Diagnosis. When D4355 is used initially to prepare the mouth for data collection it should be followed by a comprehensive oral evaluation (D0150) or a comprehensive periodontal evaluation (D0180) on a different date to proceed with gathering necessary data, inclusive of periodontal probing in order to make an accurate diagnosis. By definition, D4355 should only be used when performing it on the entire mouth. Should a patient require therapeutic treatment in one or two quadrants only, D4355 should not be reported. Most insurance claims for definitive scaling and root planing require clinical documentation that determines the diagnosis, so I would advise collecting baseline data initially when possible, or following the use of the preliminary procedure D4355 even if probing data needs to be adjusted during definitive treatment once complete debridement has occurred. Note: As a general rule, D4355 is a paid benefit only by about 30% of the contracts irrespective of the “need” to perform this procedure to prepare the mouth for adequate data collection. KAREN DAVIS, RDH, BSDH

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