Dentaltown October 2022 - 22

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payment, they allow the same benefi t as a prophy and therefore D4346 becomes worthless.
The key to SC/RP is proper charting and proper documentation. The major determining
factor is CAL, not the PD. CAL is the measurement from the CEJ, not the gingival crest. It is
the true measurement of attachment loss. Radiographs are benefi cial only when they show bone
loss and/or support the charting.
Many points already brought up in this thread are correct. The AAP defi nition is clear.
Simply put: It is scaling and root planning, not scaling or root planing. So, if you don't have a
root to plane, you can't do a D4342 or D4341.
Now here is what is on the horizon: artifi cial intelligence. There are programs that are being
developed and put into use that will read the radiographs to determine bone loss.
The advantage to us: It proves there is bone loss and supports SRP. The disadvantage to us:
Insurance uses AI on the images to determine there is no bone loss.
Lastly ... so you believe the patient needs SRP. You know the insurance company says the
patient doesn't qualify. " Mr. Smith, in my expert opinion, you have the X stage of periodontal
disease, which is an infection of the bone and tissues of your jaw. The correct treatment at this
stage is to do SRP, which unfortunately your dental plan will not pay for. Mr. Smith, you have
two choices: You can have the treatment done at $X, or you can skip treatment and have your
condition progress and worsen. What do you want to do? "
And if the patient says they want to wait? Shake their hand, say it was nice to meet them and
markshek
Member Since: 12/13/01
Post: 25 of 35
you will transfer their records to their next dentist. ■
I do what Timmy does, except I use the 4346 code for the fi rst visit and charge more.
8/24/2022
I actually used to call it " prophy one " and " prophy two. " If it's not too bad, I still would and
then charge out prophy fee each time. We have a fee of $225 for that visit. An hour is more than
enough. We tell the patient insurance will not cover it all. Hard for them to argue. They know
they have bad home care and have not had a cleaning in a very long time. So, the diagnosis is
gingivitis. Two visits.
First visit, 4346 (one hour); second visit, 1110 prophy (also one hour). Then we decide if they
need a three-month recall. I don't care if insurance pays or not. We warn the patient, but make it
clear their gums are a step away from periodontitis (bone loss). SRP is a very abused code, along
with core buildup. Aetna now asks for intraoral photos of cores. I have had many patients come
to me from DSOs having been told they need four quads of RPS and many cavities to fi ll. They
needed a prophy and lots of times zero fi llings. Dentistry has gotten sad. ■
8/24/2022
ag3dmd
Member Since: 09/27/02
Post: 33 of 35
As a former dental claim reviewer, I can't begin to tell you the number of fake claims I had
seen for SRP. Or claims that perchance came in from the same dentist, side by side, with the
charting exactly the same on different patients, or better yet, during the AI conference when the
presenter showed us the same Panorex that has been submitted in 14 different states. The key to
remember is whether or not the insurance company allows SRP, it is up to you and the patient
to decide what to do, and if you believe/know/feel/suspect that SRP is the correct treatment and
the patient agrees, then you do the SRP and charge the patient.
Is the denial of benefi ts for SRP unfair to you or unfair to the patient? That's the question you
need to ask here. Is it that the patient won't proceed with care because the insurance company
says it won't pay, and you think that's making it harder to provide care to your patient? As I see it,
nobody but the patient can tell you you can't provide the care. Is it that you relied on the insurance
company to help you convince the patient the treatment is correct? We all want insurance
companies to help our patients get care, but far too many dentists rely upon insurance to sell their
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Dentaltown October 2022

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