Periodontal Dental Insurance Claims And Billing
Periodontal dental insurance claims are a huge piece of your hygiene billing. So, it stands to reason that you want to do this well. And you want your periodontal insurance claims paid at their first submission. And within a 30-day window of time.
So, there are a few things to keep in mind. And the main thing is to know you need documentation to support your periodontal claims. Also, x-rays and maybe some notes. But let’s take a closer look!
Periodontal maintenance may make up most of your periodontal clams each day. The code to use for this procedure is D4910. Not to be confused with a “cleaning” or a “deep cleaning”. Patients who are ill-informed misunderstand this. But that’s a discussion for another day.
Periodontal Dental Insurance Claims With History
Dental insurance companies want history! And maybe even some supporting documentation as well. Generally speaking, the insurance company will want the exact dates and procedure codes and quadrants for active periodontal treatment. So, if this active periodontal treatment was not done in your office, you may have to dig. Especially if this is a new insurance carrier for your patient too!
Include Perio Chart
The claim form should include any periodontal charting. Also include dates of active periodontal treatment, as sometimes a time lapse is required between active treatment and the D4381. Then, just to be sure, include a narrative stating the patient has had active periodontal treatment and identify in writing which pockets are being treated and why.
Insurance coverage seems to be all over the map for this benefit. The code here is D4355. And this code is not covered usually if an exam is done on the same date. The idea is that there is more deposit on the teeth than will allow for a comprehensive exam. So be sure if a patient presents for initial exam not to do this or any exam on the same day! Unless benefits state otherwise. And again, you will need to verify coverage and benefits first.
Rarely Used Code
Use this code sparingly. Only if you truly cannot see to do a comprehensive exam. It’s not meant to be used a general prophy. And some insurance companies don’t even cover it. While others will pay out a prophy fee and count it towards a prophy in frequency. I would include chart notes and clinical findings in the form of a narrative when billing this code. And perhaps intraoral images might even be helpful. Just keep in mind, this code is meant to be used in extreme cases only.
Periodontal Dental Insurance Claims For Active Treatment
Active periodontal treatment is probably the second most common perio procedure you will bill to insurance. And these codes are D4342 or D4341. It all depends on the number of teeth involved in each quadrant. And each quadrant should be billed as UL< LL<UR<LR. You will want to include x-rays and perio-charting. Any clinical notes or intraoral images you have to support your claim are also helpful.
Some insurance companies limit frequency. And others do not. Some policies will cover all 4 quadrants in one appointment, and others will not. So again, this is definitely something to verify before doing. You want your patient to receive all the benefits they can. And most importantly, you don’t want to destroy any trust you have built with them.