Hygiene Codes to Maximize Insurance Benefits

Picture this: your hygienist has a full day of patients. A couple of S/RPs, a couple of new patients, and some nice recalls. Ahh… it’s a beautiful thing.

But wait! What’s that I see here? She hasn’t been using the correct CDT codes for her procedures. Oh no! Poor coding is about more than just lost revenue; it can lead to benefit claims bouncing back and over- or under-treatment.

We should periodically sit down with our hygiene teams and discuss treatment philosophies, like when to refer to a periodontist or how often a full mouth probing should be done. A super important part of this conversation is which codes can be used and when.

Below is our office protocol for a standard new patient with no periodontal concerns. Not including radiographs, we expect to see the regular prophy code (D1110) and comprehensive examination code (D0150) for their first visit. Their subsequent recare appointments would use the same prophy code for the cleaning and a periodic evaluation (D0120) for the exams. Pretty straightforward.

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Where some offices get into trouble is not correctly coding for patients who need S/RP. If the patient has significant subgingival calculus, several significant probing depths, and the other clinical signs of periodontal disease, then we should use different codes for the process. The first visit is a full mouth debridement (D4355) and the exam should be a comprehensive periodontal evaluation (D0180). The D0180 is just like a comprehensive examination but it takes into account the extra documentation and diagnosis that will be needed, and you appropriately get paid more for it. The second and third visits are spent doing S/RP (D4341 or D4342) and you may need to include local antimicrobial therapy like Arestin (D4381) and gingival irrigation (D4921).
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After the S/RP is all done, we should be bringing these patients back for a re-evaluation (D0170) 4-6 weeks later, just like we were taught in dental school. We need to determine if our therapy has worked and contemplate a referral to a periodontist as needed. At this visit, our hygienists will re-probe the areas of interest and inspect the patient’s home care. This is also a great time to review and bill for OHI (D1330) although we’ve probably been working with the patient on this since the first visit. It’s at this visit that we can also determine the appropriate recare cycle: 6, 4, or 3 months.

For future recall visits, we would use the D0120 periodic evaluation code as normal but we should not use the prophy code. If you look at the CDT, prophys are done on patients who do not have periodontal disease. A patient who has had S/RP should have a periodontal maintenance (D4910), which pays more to compensate our hygienist for the extra work they’ll have to do to keep this patient healthy.

So there it is. Quite simple, really. But I find that a lot of offices don’t correctly and consistently use hygiene codes. Print up these charts and use them as “cheat sheets” for your hygienists.

This article originally appeared on www.thecuriousdentist.com.  Reprinted with permission.

Chris Salierno

Dr. Salierno received his B.S. from Muhlenberg College and his D.D.S. from SUNY Stony Brook School of Dental Medicine. He completed his formal training at Stony Brook Hospital’s General Practice Residency program where he focused on implant prosthetics. Dr. Salierno advocates on all levels of the American Dental Association tripartite and serves as co-editor of The Surgical-Restorative Resource, a website and e-newsletter dedicated to the team approach to complex care. He has presented numerous resources for dentists including lectures, articles, podcasts, and webcasts. He lectures internationally on clinical dentistry, practice management, and leadership development.

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Last modified: July 4, 2018

5 Responses to " Hygiene Codes to Maximize Insurance Benefits "

  1. Anna says:

    Great! Helps a lot!

  2. DR.P.G.PATEL says:

    Our hygiene dept. was missing this all the time.Great work.
    Thanks
    DR.P.G.PATEL

  3. Vicky says:

    Great Tips in Coding and maximizing hygiene codes. Thank You! Vicky

  4. Modern Practice says:

    Test comment

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