CDT D4910 Dental Procedure Code
Periodontal Maintenance code D4910, this procedure continues at varying intervals, depending upon the clinical evaluation of the dentist, and continues for implant replacement or the life of the definition. The gum tissue is healthy with a minimal amount of plaque and calculus.
It includes the removal of the plaque and calculus from the subgingival and supragingival regions. Also, teeth polishing, site-specific scaling, and root planing were indicated, along with new or continuing periodontal disease depending upon diagnosis and treatment procedure later.
Dentist Perspective
- Many carriers offer limited benefits for periodontal maintenance. Some payers have limited this procedure and paid as a benefit only within 2 to 12 months of SRP.
- Many payers deny benefits unless two or more quadrants have received prior therapy. It seems confusing for patients and dentists as every carrier has different limitations and policies for this procedure.
- The dentist performs the correct procedure and simultaneously reports still benefits get denied because of the plan’s limitations. The patient thinks the provider is incorrectly performing the periodontal procedure or reporting, which leads to a negative patient-doctor relationship.
- Disclosure of the benefit in the EOB or employee benefits booklet along with alternate benefits for a lesser procedure is helpful to avoid inadvertently.
- After the procedure gets completed, a new root structure and altered architecture make the debridement of plaque and calculus more difficult. The provider should inform the patient that the reimbursement of D4910 may not be applicable for extended periods. Educate the patient that all plans have limitations and code for the rendered service.
Industry Perspective
- It is necessary to have the patient’s prior periodontal history to receive the benefit of D4910. If the patient has no claim history with the payer, then it becomes difficult to assess the benefit level available to the patient.
- To submit periodontal charting with the claim help in the determination of benefits if the payer does not have any previous periodontal history with a patient.
- Most payers electronically store claim forms, diagnostic reports, and attachments for the reimbursements. Re-submission of the diagnostic material would not be necessary for the patients with periodontal therapy history.
- As this procedure gets instituted after periodontal therapy, as stated in the code on Dental Procedures and Nomenclatures, the reimbursement requires targeted periodontal probing and a periodontal diagnosis.
- The waiting period is 8 to 12 weeks. For the different intervals of treatments, supporting documentation with the original claim submission forestall requests to determine the patient benefits.
- Plan limitations exist to the guidelines from the dental group contract and employer group.
How to minimize claim denial for the D4910 code?
- For unusual circumstances where the treatment interval is different than the one specified in the plan, the service provider should attach the supporting documentation with the original claim submission.
- For patients under the new group policy, submit the patient’s treatment history with the initial claim for D4910 for estimation.
- It is worth noting that D4910 does not include comprehensive periodontal evaluation (D0180) or periodic oral evaluation (D0120).
