b'D4346 is not benefitted, they should not submitof plan limitations such as not permitting D4910 after for reimbursement. This is a catch-22 sincesoft tissue grafting or discontinuing the use of D4910 the carrier has no perception of the codes use,two to three years after completion of the periodontal resulting in low or no coverage.treatment. Scaling and root planing (SRP) is one of the mostYour front office staff can be of great value in frequently abused codes, and as a result, carriersrecognizing those plans commonly seen in your office have placed several requirements on benefitingand being familiar with the limitations that accompany D4341 and D4342. Attachments are a must,them, since most patients are not. Preventive and and both periodontal charting and preferablynon-surgical periodontal procedures can be one of the full mouth radiographs should be submitted.biggest reimbursement headaches in the office. The Most require bone loss of at least 2mm from themore an office is familiar with the specifics of their CEJ visible radiographically. It is also helpful tomost common plans, the less frustration for both the know that if multiple areas of SRP are neededoffice and the patient will be seen.on a maintenance patient, a carrier may request proof of increased pocketing. In these cases, two periodontal chartings six months to a year apart are necessary. Unless there are extenuating circumstances, four quadrants are not covered if performed at one appointment. If there areSubmit your third-party questions to extenuating circumstances, such as health issuesinsurance@perio.org. Members with coding or long-distance travel, a short narrative can causequestions or difficulties with insurance claims a carrier to reconsider. Plan limitations also existcan also contact Pam Throw at 312-573-3241 that limit the frequency of SRP, with most fallingor email pamela@perio.orgin the range of every 2-3 years. It is always best, if there is any question, to submit a pre-treatment estimate. After completion of SRP, a few carriers require a re-evaluation, D0171, before any periodontal surgery is completed. Last, but by no means least, D4910 can cause some confusion. The descriptor for periodontal maintenance includes specific requirements forAAP meets with carriersits use that distinguishes it from the prophylaxisThe AAPs Insurance Consultant attended the annual code, D1110. Among these are both supra- andmeeting of the American Association of Dental subgingival debridement and subgingival scalingConsultants in May. The four-day meeting provided and root planing in site specific areas to maintainthe opportunity to network with representatives from health. Of course, a history of active periodontalseveral carriers. One day was spent in meetings therapy is also required. If a patient is only seenwith individual carriers, reviewing their current in the periodontal office, the correct codingpolicies and discussing issues AAP members have would always be D4910. Many times, generalexperienced including coding, administrative issues, dentists alternate with the periodontist and codeand claims denials. This interaction provides an their appointments as D1110. There is a distinctexcellent environment for developing relationships difference in the procedure, however. Somewith the carriers and the opportunity to promote the carriers cover two cleanings per year regardlessAcademys philosophy as well as consensus reports of codes. Others allow four if they are alternated.and white papers.A few will cover four D4910s per year. It is important to know the interval necessary between maintenance appointments since most plans strictly adhere to these timeframes. Be aware, too, AAP Periospectives| 25'