b'FOR YOUR PRACTICEAsk the Coding CoachDear Coding Coach: D1110, adult prophylaxis, is one of the most We often get questions related to the use of theutilized codes in CDT. A request was made to the American Dental Associations Code Maintenance codes for prophylaxis, periodontal maintenance,Committee to develop a code for cases that scaling in the presence of inflammation, full mouthrequire more than isolated scaling, which would debridement, and scaling and root planing. Whatsresult in a more complicated and time-consuming the best way to differentiate these procedures? Howprocedure. The Committee agreed and developed do carriers reimburse for each procedure? Can Icode D4346. This code is appropriate for patients alternate codes D1110 and D4910?with generalized moderate-to-severe inflammation resulting in gingivitis. No bone loss is present, Some of these codes are straight-forward, while othersand pocketing is supragingival. It is strongly are more subjective. Although D4355, full mouthrecommended that a full mouth charting indicating debridement, and D4346, scaling in the presence ofnot only pocket depths but also bleeding on gingival inflammation, are codes in the periodontalprobing is completed prior to the procedure.category of the CDT book, they are not limited toPhotos also will support the presence of periodontal patients. D4355 is specifically used whengeneralized moderate to severe gingivitis. a patient has extensive calculus and deposits, usuallyRemember, too, that the procedure is a full mouth supragingival but many times also subgingival, that mustprocedure. An example of the type of patient that be removed prior to an evaluation. A comprehensivemight fall into this category would be an active periodontal evaluation could not be adequately performedorthodontic patient with poor homecare and at the same visit since inflammation would prevent thepseudo-pocketing around the appliances. Carriers determination of pocket depths and attachment loss. Incoverage varies greatly for D4346, from no some cases, a D0191, assessment of a patient, couldbenefits, to benefiting the same as a prophylaxis, be completed to identify disease and provide limitedto benefitting similar to one quadrant of scaling care. Most carriers do not reimburse for full mouthand root planing. Most will put plan limitations on debridement.frequency, however. Some dentists feel that since AAP Periospectives| 24'