How do I bill my D4910?

Answered by Willie Powers

To bill for D4910, it is important to follow certain guidelines and provide proper documentation. D4910 is indicated after active periodontal therapy, which typically includes scaling and root planing. Here is a detailed explanation of how to bill for D4910:

1. Complete Periodontal Charting and Probing: Before initiating any periodontal therapy, it is crucial to have a comprehensive periodontal charting and probing done. This includes recording measurements of pocket depths, attachment levels, bleeding points, and any other relevant information. This documentation serves as a baseline for evaluating the progress of treatment and justifying the need for D4910.

2. Active Periodontal Therapy: The initial phase of treatment often involves nonsurgical periodontal therapy, such as scaling and root planing. This procedure aims to remove plaque, calculus, and bacteria from the root surfaces and pocket areas. It is essential to document the dates of these procedures and include any site-specific scaling and root planing performed.

3. Evaluation: After completing the active periodontal therapy, a reevaluation is necessary to assess the response to treatment and determine the need for further intervention. This evaluation should include a thorough examination of the periodontal tissues, recharting, and re-probing. Any changes in pocket depths, attachment levels, or other clinical parameters should be documented.

4. Maintenance Phase: If the reevaluation shows signs of disease stability or improvement, the patient can enter the maintenance phase. D4910, or periodontal maintenance, is performed at regular intervals to prevent the recurrence or progression of periodontal disease. This typically involves professional teeth cleaning, oral hygiene instructions, and monitoring of periodontal status.

5. Documentation: Accurate and detailed documentation is crucial for billing D4910. Each visit should include the date, specific procedures performed (e.g., D4910, site-specific scaling and root planing), and any relevant findings or changes in the periodontal condition. This documentation should be maintained in the patient’s records for future reference and insurance purposes.

6. Insurance Verification: Before billing D4910, it is important to verify the patient’s insurance coverage and benefits. Some insurance plans may have specific requirements or limitations for periodontal maintenance procedures. Understanding these guidelines will help ensure proper reimbursement and avoid any potential billing issues.

7. Billing Codes: When submitting claims for D4910, you should use the appropriate dental procedure codes. The most commonly used code for D4910 is “D4910 – Periodontal maintenance.” It is important to accurately code and describe the procedures performed to avoid claim rejections or delays.

Billing for D4910 requires proper documentation of complete periodontal charting and probing, as well as the dates and details of any site-specific scaling and root planing performed. Regular reevaluations and maintenance visits are necessary to justify the need for D4910. Accurate coding and insurance verification are also essential for proper reimbursement.