2022 Improving
oral systemic Periodontal Treatment Acceptance
Today, most dental treatment providers clearly understand the importance of periodontal disease and the ramifications it can have on patients’ health. So why are fewer than 5% of patients receiving the treatment this disease requires?
creating a successful periodontal treatment program
There are several factors required to create a successful Periodontal Program. First, there must be an office protocol for periodontal disease diagnosis that reflects the vision of the practice.
Second is the commitment to change from the dental team. The entire team must agree on the protocol and work together to execute, including providing patient education and motivation. Third, scheduling must allow enough time for the hygienist to provide treatment and operatory capacity to support that treatment. Finally, periodontal disease coding must be done properly to ensure appropriate insurance reimbursement and patient compliance. Proper coding provides a means for helping patients achieve ideal oral health and proper insurance coverage.
Sadly, even though science and technology related to diagnosis and treatment of periodontal disease have significantly changed over the past 30 years, many dental practices are stuck in a “business as usual” mindset. Despite the prevalence and persistent nature of periodontal infections, more than 70% of dental offices do not perform full mouth probing and charting on a regular basis.
The popular “adult prophylaxis” procedure is being offered to patients who have all the clinical evidence of an active periodontal infection. We must start by informing patients of their current disease status and making recommendations for their treatment. The next step is to use the proper CDT 2011-2012 codes for billing and help the patient understand what these codes mean and why they are being used. Periodontal Treatment Program Goals should be customized for each individual practice but the following are recommended:
Periodontal treatment Program Goals
- Use Total Health education to motivate the patient to accept the necessary recommended care.
- Increase the patient’s level of periodontal health.
- Help the patient receive maximum insurance benefits.
- Make sure the hygienist is paid for the procedures she/he is actually providing*
- Increase the practice profitability, by using the correct periodontal codes.
*It’s important to understand that many hygienists are already doing the work, and should be paid for the work that they are doing. The use and documentation of proper billing codes will get the offices paid for the proper periodontal treatments.
1. Diagnosing Periodontal Disease
The Periodontal Examination Everything begins with the gathering of the clinical data necessary for the diagnosis of periodontal disease. Full Periodontal Treatment Probing Charting and X-rays generally need to be sent to the insurance company to demonstrate presence of periodontal disease. They will not allow the patient coverage without these. Full Periodontal disease Charting involves 4 measurement or 6 measurement points of pocket depth on each tooth. Notation of tooth mobilities, furcation involvements, occlusal trauma, and tissue attachment abnormalities, bleeding points on probing, etc. must also be included. All of this supporting documentation demonstrates active disease and some evidence of bone loss and allows you to use proper periodontal treatment insurance coding. Be prepared with scheduling, it will take extra time to probe and chart and can be done manually with the help of an assistant, voice recorder, automated probes or computer recorders. Computer voice recorders can be extremely effective and can be done without the help of an assistant.
2. Explaining periodontal disease to the Patient
During the exam, give the patient a mirror and show them at least one bleeding area. Use an Intra-oral camera. If patient is complaining about bad breath let them know it will clear up after treatment. Touch the patient’s hand with the probe and discuss pain and bleeding associated with touch. Explain that any probing reading over “3” is not good. It is important that the patient hear the numbers and recognize the importance of the probing depths. Call out the Pocket Depths during the exam – this gives a patient a warning so they are prepared to accept the news.
3. Confirm periodontal disease diagnosis with X-RAYS
Periodontal Treatment X-RAYS Full Series X-Rays are appropriate for both periodontal and non-periodontal patients. Full series x-rays show bone levels of periodontal disease patients better than routine bitewing x-rays. A full series should generally be taken on new patients rather than vertical bitewings.
Codes for Periodontal Treatment X-RAYS
- Full Series X-Rays (D0210) are appropriate for both periodontal and non-periodontal patients. Full series x-rays show bone levels of periodontal patients better than routine bitewing x-rays. A full series should generally be taken on new patients (D0210) rather than vertical bitewings. Full series x-rays are payable every 3-5 years depending on the plan.
- 7-8 Vertical Bitewings (D0277) show bone levels/loss better than regular (horizontal) bitewings (D0274). Some use (D0277) for annual checkups instead of four bitewings (D0274). D0277 is in reimbursement “no man’s land.”Some insurance companies “downgrade” and pay as four bitewings (D0274). Some insurance companies “up code” D0277 to a full series (D0210), if available at the D0277 fee and then refuse to pay for the full series (D0210) when taken. Some insurance companies will accept a panorex (D0330) and vertical bitewing’s together but all companies will accept a full mouth series.
4. Achieve periodontal Treatment Plan Acceptance from Patient
After the doctor reviews the pocket depth readings, bleeding-on-probing (BOP) readings, the Clinical Attachment Levels (CAL), and the full-series x-rays for bone levels and for extent of bone loss, he/she confirms the diagnosis of periodontitis and prescribes a Treatment Plan. Each level of periodontal disease requires a different treatment plan and uses different coding, sequences, treatments, and appointment lengths. The hygienist then discusses the prescribed treatment plan with the patient. This should be presented so that it’s clear the patient is involved in lowering/improving their pockets depths, it will be a joint effort between the patient and the dental team. Print out the periodontal chart and send it home with patient. Explain that pocket depths will be compared to track the progress during the next appointment. Help patients understand that treatment now may help them avoid Periodontal Surgery down the road. After the patient understands and accepts the treatment plan, transfer to the Financial Coordinator for financial arrangements and appointment scheduling.
AAOSH offers chairside tools and resources to assist your team in periodontal testing and treatment plans. Download the free infographic bundle and start testing today.
