My question pertains to re-evaluation appointments for scaling and root planing. Our office always performs a 5-week re-evaluation after localized or full mouth scaling and root planing (SRP). In the past, dental hygienists have used a D4910 (periodontal maintenance) code at the 5-week re-evaluation appointment, which we did not submit to insurance, and which the patient was responsible for in addition to the cost of the SRP. We then put the patients on a 3-month recare using the D4910 code. Patients do not want to come back and pay for this re-evaluation appointment, and the current dental hygienists do not feel comfortable charging the patient for a periodontal maintenance even if we clean at the re-evaluation. We feel especially strongly about this when we perform localized SRP. My question is should the 5-week re-evaluation be included with the price of SRP? Is there a separate code that can be used to account for the time the patient spends in our chair? And should the charges for full mouth SRP re-evaluation vs localized look the same or different? Thank you!
My short answer is there should be no separate fee for the reevaluation. I believe the reevaluation time should be incorporated into the comprehensive fee for scaling and root planing whether it is provided locally or for all four quadrants. I believe this to be true even if additional debridement is provided at the reevaluation.
To review, D4910 is the code for a periodontal maintenance visit. Patients generally expect to have periodontal debridement with removal of supra- and subgingival plaque and accretions during that visit. It is interesting that the dental insurance company is not notified of the code entered for the reevaluation; however, the patient is billed for this fee associated with the maintenance code. In addition, dental insurance companies will only pay for this fee if charged exactly 3 months and 1 day prior to completion of scaling and root planing. Otherwise, dental Insurance companies do not feel payment is justified for this visit.
I agree with the insurance companies on this issue. The Initial fee for scaling and root planing is a comprehensive fee charged for effective subgingival scaling and root planing under local anesthesia. The fees are charged per quadrant. Typically, clinicians complete four quadrants of SRP in two visits. Insurance companies will not cover the fee if all four quadrants are charged out in a single visit. Their rationale is that the treatment may likely be ineffective, as it is rushed into one visit. Having said that, the argument could be made that an effective course of scaling and root planing may actually take more than two visits depending on the amount of disease present. In my practice, this happens from time to time. If a third visit is needed to complete scaling and root planing, the patient is not charged for this visit. The insurance or the patient has already paid for four quadrants of periodontal scaling and root planing. The fee is not based on the amount of time spent on the patient but rather on the procedures provided per quadrant. Lawyers charge by the hour, plumbers charge by the hour, but dentists and medical professionals charge by the procedure.
As you noted, patients may receive additional therapy during a reevaluation visit. In my opinion, they have already paid for this—it is simply a continuation of phase-one therapy. Another aspect of the reevaluation is to determine whether additional periodontal care is needed. That care may involve setting up a maintenance program or determining that vertical defects and/or subgingival calculus are still present; thus, indicating the need for surgical access to debride the area completely.
If further periodontal surgical treatment is needed, it's not likely that a patient will want to pay additional money to hear this news. My advice is to focus on success not in the short-term but rather in the long-term. This is relative to both therapy and office finances.