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Delta Dental of Virginia continuously monitors network feedback, looking for ways to improve its processes and procedures and to find opportunities to better communicate with our dentists. One procedure that raises many questions is scaling and root planing. This article provides suggestions to help streamline claim submissions for scaling and root planing procedures.
D4341: periodontal scaling and root planing — four or more teeth per quadrant is a therapeutic procedure for patients with diagnosed periodontal disease, designed to remove cementum or dentin that is diseased or roughened by calculus, either as definitive treatment and/or pre-surgical care.
Claim submissions need to demonstrate documentation of bone and clinical attachment loss; pockets should be greater than 4mm. Where less than four teeth in a quadrant meet the criteria, the procedure may receive an alternate benefit of D4342: periodontal scaling and root planing — one to three teeth per quadrant. Scaling and root planing should not be billed at the same time as other non-surgical services and would be considered integral to periodontal surgery billed on the same date of service.
In the absence of any evidence of bone loss or attachment loss, the claim submission may receive an alternate benefit of D4346: scaling in the presence of generalized moderate or severe gingival inflammation-full mouth, after oral evaluation. This procedure is designed to manage moderate to severe gingival inflammation in the absence of diagnosed periodontitis and should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures. If the submission does not meet the criteria for either scaling and root planing nor a D4346, an alternate benefit of D1110: prophylaxis — adult may be applied instead.
Documentation should support the submission and needs to include:
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Full mouth series of radiographs or periapical and bitewing X-rays of good diagnostic quality, which clearly show all teeth in the quadrant or quadrants being treated;
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Periodontal charting that includes probing depths and clinical attachment loss;
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#1 and #2 should be within 12 months of the treatment date.
If a submission was denied or received an alternate benefit and you wish to appeal, please include additional documentation supporting the appeal. This could include additional X-rays, photos, chart notes, and/or a narrative. Appeals must be received within 180 days of the denial and sent in writing via:
Email: AppealsAdmin@deltadentalva.com
or
Mail: Appeals Department
Delta Dental of Virginia
PO Box 12483
Roanoke, VA 24026
Michael Weitzner, DMD, MS
Dental Director, Delta Dental of Virginia
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