b'FOR YOUR PRACTICEAsk the Coding CoachDear Coding Coach: as D4355. Correct coding for this type of appointment would be When can I proceed with additional treatment afterD4355 and D0191 assessment. performing gross debridement on a patient? ForThe new wording in the descriptor, however, does allow other example, if a patient has a large carious lesion that isevaluations to be performed on the same day. This would causing pain, can I place a temporary filling until theyinclude D0120 periodic evaluation, new or established patient; can be seen by their general dentist? D0140 limited oral evaluation, problem focused; or D1050 comprehensive oral evaluation, new or established patient. The D4355 code is used for gross debridement. This means that when a patient is seen and has substantial amountsIt can be confusing that a D0150 comprehensive oral evaluation of calculus, debris, and stains, which make it difficult towould be allowed immediately after D4355 gross debridement. determine the necessary treatment, then gross scaling andRemember, however, that the descriptor for D0150 states that debridement is performed. In cases where it is evident that aonly a periodontal screening is needed.periodontal problem exists (even after gross scaling), a finalThis descriptor was changed due to the need, in rare cases, diagnosis cannot be made due to the inflammation present,to proceed with some form of treatment on the same day as causing bleeding and edema. In these cases, it is consideredgross debridement. For example, this can include a patient best to appoint the patient later to perform a comprehensivewho is having therapy under sedation, a patient who travels periodontal evaluation. Healing will have occurred, resultinga far distance for treatment, or a patient who has medical in more accurate recording of not only pocket depths, butcomplications which compromise general care. also bleeding on probing, furcation involvement, and other components of a comprehensive periodontal evaluation,To answer the original question: the correct coding would D0180. The new wording of D4355 specifically states in thebe D4355 and D0140, and then D2940 for the temporary descriptor that D0180 is not to be performed on the same dayrestoration. AAP Periospectives| 18'