Understanding scaling and root planing (SRP) and soft tissue management (STM) CDT codes can be challenging, even to the most seasoned insurance biller. Identifying the supportive clinical documentation that is necessary is important for your insurance billing success - financially and legally.
In this article, you will learn how to bill for scaling and root planing for periodontal disease. There are a few different CDT codes that could apply, depending on the patient’s diagnosis and treatment plan. With this knowledge, you will be able to accurately submit insurance claims and remain compliant when collecting reimbursement.
The gums can become swollen and red, and they may bleed. If gingivitis is left untreated, over time, this condition can advance to periodontitis and require SRP.
When billing for SRP there are a few different CDT codes you may use depending on the patient and their diagnosis, such as:
D4341 Periodontal Scaling and Root Planing- four or more teeth per quadrant
D4342 Periodontal Scaling and Root Planing- one to three teeth per quadrant
Pro Tip - When billing SRP submit your claim with the following documentation:
The teeth #’s involved, narrative detailing active periodontal disease, periodontal charting that shows a pocket depth 4mm or higher, any bleeding on probing, suppuration, mobility, furcation involvement, clinical attachment loss, x-rays showing radiographic bone loss, the periodontitis stage, etc.
There are several coding options for SRP - depending on the patient’s diagnosis
Another commonly used CDT code for soft tissue management is D4346 - Scaling in the presence of gingival inflammation. This code is used to report therapeutic treatment of patients with generalized moderate to severe gingival inflammation, with or without pseudo-pockets but do not have bone loss. Do not use this bill this code in conjunction with a prophy or SRP.
The code D4355 is a Full Mouth Debridement to enable a comprehensive oral evaluation and Diagnosis on a subsequent visit.
This code is used when the patient has a large amount of calculus, plaque or debris that prevent the examination from being completed. This code is not definitive treatment and is often misunderstood and billed incorrectly. If the evaluation is also submitted on the same date, the code will be denied. The patient will need a subsequent visit to complete the examination.
Another code you might use to document your treatment is D4910 for Periodontal Maintenance (not including evaluation). You would submit the date of last SRP/gingival flap/osseous surgery. Usually, insurance has a 90-day exclusion after SRP/gingival flap/osseous surgery.
Keep in mind the patient may be subject to deductible and frequency limitations. They may also be limited to only a 24-36 month post-SRP/gingival flap/osseous surgery.
If you need to appeal an SRP claim, consider asking for the alternate benefit of prophy D1110 (do not change billed code). And make sure to inform the patient about periodontal maintenance vs prophy and their plan’s estimated benefits.
Understanding the appointment sequence and proper coding may be difficult until you learn to navigate properly using these soft tissue management codes.
Make sure that you have the most recent CDT 2023 coding book. Read through the coding book and compare it to your current software code lists. Update your software by inactivating the deleted codes and adding any new codes that you may have missed in the past.
Why is it important to use the proper CDT code when billing out Periodontal Treatment?
Proper CDT coding is important to avoid insurance reimbursement denials and/or delays, fraudulent claims, insurance audits, and possible damage to the practice’s reputation.
Each patient’s diagnosis is going to be different, so everyone’s treatment plan is going to be different. Because of this, keeping up with when to properly document a CDT code on an insurance claim can be challenging - there isn’t a one size fits all CDT code for periodontal disease.
And when you choose the wrong CDT code for your insurance claim, you could also face a denial. Insurance claim denials lead to delays in payment for your dental practice. The longer a claim goes without being paid, the less likely it is to ever be paid. And insurance loves finding new ways to deny your claim!
So you have to stay ahead of the curve when it comes to CDT coding, for the sake of your practice’s cash flow.
You can also face legal issues for coding incorrectly on an insurance claim. Being reimbursed for the wrong CDT code can lead to insurance fraud which may also jeopardize your practice - even if it was just a mistake.
And if your patient is awaiting reimbursement from their insurance claim, they might blame the delay on you. This can lead to patients leaving your practice, which can cause a loss in trust and revenue.
There are many additional codes related to Soft Tissue Management and your patients who need SRP. Learn the proper sequence to optimize your patient’s insurance benefits and keep your patients from slipping out of their periodontal maintenance visits.
Understanding when and how to bill for different treatments for periodontal disease can be confusing, but with this guide to billing for SRP, some of that confusion should be cleared up. It’s important to understand CDT codes related to periodontal disease because of how it can affect your cash flow as well as your reputation as a dental practice.