The information provided here is for educational purposes only and should not be construed as legal, medical, or financial advice. Always consult with a licensed professional for specific guidance related to your practice and compliance with state and federal regulations.

Answer: If you're placing a desensitizer, use code D9910 for desensitizer and D9911 for desensitizing resin. The insurance company will most likely deny the code and consider it inclusive of the crown preparation or composite.

If you're in-network, you may need to take the write-off, depending on the group plan limitations. If you're out-of-network, charge your fee for these codes. Code what you do, always. Insurance will do what insurance does.

The information provided here is for educational purposes only and should not be construed as legal, medical, or financial advice. Always consult with a licensed professional for specific guidance related to your practice and compliance with state and federal regulations.

Answer: When a patient declines Scaling and Root Planing (SRP) treatment and requests a "regular cleaning," the first step is patient education. SRP is a therapeutic treatment for periodontal disease, not a simple "deep cleaning." The language you use to explain this makes a significant difference in how seriously patients take your recommendations. A "regular cleaning" (prophylaxis) is meant for patients without active periodontal disease, and providing it to someone requiring SRP could exacerbate their condition.

How to Approach the Situation:

1. Use Visuals and Simple Explanations: Show the patient their periodontal charting, X-rays, or intraoral photos to clearly illustrate the clinical need for SRP. Help them understand the risks of untreated periodontal disease, which can lead to tooth loss and more invasive treatments in the future.
2. Understand Their Concerns: Identify the patient’s barriers to care—whether related to cost, discomfort, or time. Address each concern and provide solutions, such as offering payment plans, explaining sedation options, or suggesting phased treatment, even if it means completing SRP one quadrant at a time.
3. Offer Alternative Options: If cost is a significant concern, explore financial options like phased treatment or payment plans. If these options are still out of reach for the patient, a referral to a community health clinic can protect the doctor and the practice from potential malpractice lawsuits. For patients anxious about discomfort, offer anesthetic, sedation, nitrous oxide, or anxiety medication to make the procedure more comfortable.
4. Informed Refusal: If the patient continues to refuse SRP, document the decision thoroughly. Informed refusal occurs when a patient, after receiving full information about the treatment, risks, benefits, and alternatives, chooses not to proceed. Document the reasons for refusal—whether they are financial, time-related, fear-based, or due to other priorities—and ensure the patient acknowledges the risks of refusing treatment. This protects both the practice and the patient.
5. Explain the Risks of Refusal: Make it clear that refusing SRP will lead to disease progression, resulting in more complex and costly treatments in the future. It's essential to document this conversation, as it does not absolve the dentist from liability. Although the patient's decision must be respected, the dentist still has a duty to act in the patient's best interest.
6. Deciding on Continuing Care: If the patient repeatedly refuses necessary treatment, you may need to reconsider whether to continue care. This decision requires balancing patient autonomy with your responsibility to ensure they receive appropriate treatment. Continuing care without providing necessary treatment could be considered supervised neglect.

The information provided here is for educational purposes only and should not be construed as legal, medical, or financial advice. Always consult with a licensed professional for specific guidance related to your practice and compliance with state and federal regulations.

Answer:

No, the general practice cannot use the periodontal maintenance (PM) code (D4910) unless the patient has undergone Scaling and Root Planing (SRP) (D4341 or D4342) or another form of active periodontal therapy. The D4910 code is specifically for patients in the maintenance phase following active periodontal treatments such as SRP, Osseous Surgery (4260), or Flap Surgery (D4240), whether performed by the general dentist or periodontist.

If you have written documentation, like a letter or email from the periodontist, outlining the dates and details of periodontal treatment, the general practice can use D4910 for all future maintenance visits. Make sure to submit the patient’s treatment history to dental insurance as evidence, helping the patient qualify for benefits.

Key Takeaway:
The D4910 code is only applicable to patients who have undergone SRP or specific periodontal treatments and are now in the maintenance phase. If SRP has not been performed or the patient does not have periodontal disease, use alternative codes like D1110 (Prophylaxis) or D4346 (Scaling in the presence of moderate or severe gingival inflammation).

The information provided here is for educational purposes only and should not be construed as legal, medical, or financial advice. Always consult with a licensed professional for specific guidance related to your practice and compliance with state and federal regulations.

Answer: Yes, you still bill D1110, the definition of the prophylaxis code includes natural teeth and implants. You may use D9932 to clean and inspect the upper denture. Both codes can be billed to insurance on the same date of service.

The information provided here is for educational purposes only and should not be construed as legal, medical, or financial advice. Always consult with a licensed professional for specific guidance related to your practice and compliance with state and federal regulations.

Answer: In Colorado, dental hygienists can operate independently without the supervision of a dentist, and they are permitted to submit claims for procedures like D4341 (Scaling and Root Planing). However, when submitting claims, hygienists must ensure the documentation is complete and meets the clinical requirements of the patient's insurance provider.

Key Factors for Submitting D4341 Claims:

1. National Provider Identifier (NPI): Hygienists need a National Provider Identifier (NPI) number to submit claims. According to Colorado regulations and the American Dental Hygienists’ Association (ADHA), hygienists must obtain their own NPI number to facilitate the submission of claims to third-party payers.
2. Documentation Requirements: Hygienist notes must include detailed clinical findings, like periodontal charting, pocket depths, bleeding on probing, clinical attachment level, and radiographic evidence of bone loss, to support the need for SRP. While hygienists can document this independently, ensuring compliance with payer-specific guidelines is critical. A prescription from a dentist may be necessary.
3. Insurance Carrier Policies: Some insurance companies may require additional documentation or may have specific policies regarding claims from independent hygienists. If the hygienist's office is not part of a Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO) network, claims may be reimbursed at a lower rate or treated as out-of-network.
4. Reimbursement and Claim Submissions: Dental hygienists in Colorado can submit claims directly to insurance companies, but they must verify if the carrier recognizes independent providers and what documentation is required.
5. Medicaid and Third-Party Reimbursement: For Medicaid claims or other third-party reimbursement, it's essential to confirm eligibility with both state and federal regulations, as some payers may not reimburse claims submitted by hygienists directly.

Key Takeaway: In Colorado, claims for D4341 can be submitted by a dental hygienist-only practice, provided the hygienist has an NPI, adheres to detailed clinical documentation protocols, and complies with payer requirements. It’s important to check with the patient's insurance company to confirm the claim will be accepted and that the practice meets all reimbursement criteria.

Supporting Information: Colorado Dental Laws and How A Dental Hygienist May Achieve Direct Reimbursement

The information provided here is for educational purposes only and should not be construed as legal, medical, or financial advice. Always consult with a licensed professional for specific guidance related to your practice and compliance with state and federal regulations.

Answer:

The information provided here is for educational purposes only and should not be construed as legal, medical, or financial advice. Always consult with a licensed professional for specific guidance related to your practice and compliance with state and federal regulations.

Answer: The current procedure code you are using, D9933 cleaning and inspection of removable complete denture, mandibular, is incorrect because it is not implant-related. This code is for an edentulous mandibular arch.

The appropriate codes are below:

The information provided here is for educational purposes only and should not be construed as legal, medical, or financial advice. Always consult with a licensed professional for specific guidance related to your practice and compliance with state and federal regulations.

Answer: The current procedure code you are using, D9933 cleaning and inspection of removable complete denture, mandibular, is incorrect because it is not implant-related. This code is for an edentulous mandibular arch.

The appropriate codes are below:

The information provided here is for educational purposes only and should not be construed as legal, medical, or financial advice. Always consult with a licensed professional for specific guidance related to your practice and compliance with state and federal regulations.

Answer: The closest code to describe this appliance is D9944 occlusal guard - hard appliance, full arch

Removable dental appliance designed to minimize the effects of bruxism or other occlusal factors. Not to be reported for any type of sleep apnea, snoring or TMD appliances.

Even if the guard has soft and hard components, the hard appliance code is appropriate. Code it per arch.

The information provided here is for educational purposes only and should not be construed as legal, medical, or financial advice. Always consult with a licensed professional for specific guidance related to your practice and compliance with state and federal regulations.

Answer: It is appropriate to use D7921 collection and application of autologous blood concentrate product for the plug, even if you press it to flatten it, as the code includes the application of the blood products.

If you are using a resorbable membrane, the appropriate code is D7956 guided tissue regeneration, edentulous area - resorbable barrier, per site

This procedure does not include flap entry and closure, or, when indicated, wound debridement, osseous contouring, bone replacement grafts, and placement of biologic materials to aid in osseous regeneration. This procedure may be used for ridge augmentation, sinus lift procedures, and after tooth extraction.

The following codes are only appropriate for periodontal defects around natural teeth.

D4266 guided tissue regeneration, natural teeth - resorbable barrier, per site

D4267 guided tissue regeneration, natural teeth - non-resorbable barrier, per site.

The information provided here is for educational purposes only and should not be construed as legal, medical, or financial advice. Always consult with a licensed professional for specific guidance related to your practice and compliance with state and federal regulations.