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.
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!
If you are verifying insurance for a new patient, get their history on this! It’s a fabulous way to find out what your patient has had done previously. When verifying procedure coverage, ask history too! Ask history of D4910. And also ask history for active periodontal treatment. Along with the effective date of the policy.
You may also want to attach history of prior periodontal maintenance procedures. If this is an existing patient that has had a change of insurance, you definitely want to include this. And with a new insurance carrier for an existing patient, include their most current x-rays and periodontal chart as well. It may seem like overkill, but the idea is to give them all they need up front. This way the payment or processing of the claim isn’t delayed.
Localized Delivery of Chemotherapeutic Agents
Most carriers do not cover this procedure as part of their contract. The code for this procedure is D4381. And this procedure is typically performed after active periodontal therapy to treat individual pockets. And some insurance companies will cover this with limitations. So be sure to find out when you verify benefits what this benefit is if you provide the service.
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.
Full Mouth Debridement
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.
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 Periodontal 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.
Periodontal Dental Insurance Claims Follow Up
As will all unpaid dental insurance claims, follow these up after 30 days. Call the insurance company to make sure they received the claim. And you also want to make sure they have everything they need. If there is any delay at all, let your patient know. It’s critical to keep your patients in the loop on what’s happening with their insurance claims. Don’t wait until it’s a problem before letting them know. And nothing is more frustrating than calling a patient 6 months later to tell them a claim wasn’t paid.
Periodontal dental insurance claims are pretty easy once you get the hang of it. It is important to include everything the insurance company might be looking for. And honestly, when in doubt, add it! If you think an image or a narrative will help, add it! This will also be great documentation to be able to share with your patient. Especially if a claim is denied or needs an appeal.
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