b'FOR YOUR PRACTICEAsk the Coding CoachPeriodontal offices realize that insurance claimscan also help support the need for treatment. Also, submission and follow-up take up a significant amountcurrent radiographs of the area to be treated should of time and require quite a bit of patience. Anythingbe submitted. As with most procedures, it is best to that helps reduce these frustrations is welcome.submit a pre-treatment estimate to determine benefits. Experience definitely helps; and pooling the experienceHowever, be aware that if an office routinely provides of several offices is even better. For this issue ofa narrative and submits requests for four quadrants Periospectives, the Coding Coach will provide somefrequently, utilization problems with a carrier can result. insight into various experiences that may help the claims submission process as well as help you andPeriodontal Maintenanceyour patients better understand reimbursement. Periodontal maintenance can be a challenge when submitting for benefits. Some policies limit periodontal First, recognize that each patient walking through themaintenance to within two years of active treatment. door has an insurance policy that should be viewedBenefiting two visits annually is not unusual, while individually. Coverage is determined by an agreementothers permit four. In a few policies, if an adult between the employer and the carrier, and there areprophylaxis (D1110) is submitted, whether by the as many policies as there are employers. Many planperiodontist or a general dentist, this automatically limitations may be unique for that policy. It helps tomakes the patient ineligible for D4910, periodontal understand what many of those limitations are whenmaintenance. D4910 is probably the procedure code discussing payment with a patient.that has the most varied requirements among carriers Scaling and Root Planing Plan Limitations and policies.Most policies have a plan limitation that denies scalingSoft Tissue Graft Plan Limitationsand root planing completed within a certain amount ofSoft tissue grafting has varied plan limitations, time (usually 24 months) of the previous scaling anddepending on the policy. For example, many policies root planing. Many policies will not allow four quadrantslimit the number of free gingival grafts or connective of scaling and root planing to be completed at thetissue grafts to two per quadrant annually. Most same appointment. If four quadrants are completed,of the time, a frenectomy is considered an integral then the periodontist may have to absorb the costpart of a soft tissue graft and cannot be reimbursed of the two quadrants denied, or the patient may beseparately. If both are submitted, carriers may pay responsible for payment.for the most inclusive procedure (the soft tissue At times, four quadrants will be allowed. For example,graft) and the frenectomy will be denied, which will if a patient travels a significant distance for thethen lead the provider to writing the fee off or billing appointment, must go off certain medications, orthe amount to the patient. The only exception to requires sedation, then there are times that fourthis is if the frenectomy is performed at a separate quadrants will be reimbursed. Another example isappointment, usually several weeks prior to the graft. if a cancer patient is undergoing treatment and theSome policies deny soft tissue grafts on primary teeth, physician requests dental treatment, the 24 monthseven if they are retained in the adult dentition. In all waiting period may be omitted and four quadrants willthese cases, denials can be appealed with additional be allowed. In these cases, a narrative explaining theinformation, which may include diagnostic photos. extenuating circumstances should be submitted withPhotos are an excellent way to demonstrate the need the original claim. Remember, too, that periodontalfor treatment. An appeal does not automatically mean charting indicating changes since the last maintenancereimbursement, however.appointment or most recent scaling and root planing AAP Periospectives| 26'