Dentaltown December 2019 - 40

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Practice Whisperer
Member Since: 07/22/11
Post: 39 of 58

Well, that is the misnomer with CAL, which is the same letters for clinical attachment loss
and clinical attachment level. A normal healthy patient has GM of 0mm, and 2-3mm PD, adding up to CAL of 2-3mm. More accurately, CAL in this instance is clinical attachment level.
To get a true clinical attachment loss, you would need to account for this normal. As for
your, or any, software, you can input GM of zero or negative-just because you don't insert the
numbers does not mean they cannot be. The problem this entire thread is about is insurance
companies debating on whether your information is accurate. Because perio is an inflammatory
condition, and inflammation leads to swelling, it is not unexpected to see swollen tissue in perio
patients. This swelling can often be up to 2-3mm. Hence, when you get PDs of 4-5mm and no
GM marked, they can easily argue (right or wrong) that the pseudopockets will subtract from
your PDs.
I have been on the phone with insurance dentists several times arguing perio, especially in
early stages. Having GMs marked is the only way to win those debates. And they are correct,
too-without marking GM, PD does not mean much because you have no point of reference to
determine the true status of the tissues. ■
8/24/2019

Bobkae
Member Since: 05/19/03
Post: 41 of 58

I think lack of FMD on a separate appointment is the reason for denial.
Code 4355 states that:
"The ADA descriptor of the code states, 'Full-mouth debridement involves the preliminary
removal of plaque and calculus that interferes with the ability of the dentist to perform a comprehensive oral evaluation. Not to be completed on the same day as D0150, D0160 or D0180.' "
So once the initial calculus and stuff is removed by FMD, you can then do perio probing and
exam and determine if SRP is indicated. The insurance companies feel-and rightly so-that
with all that supragingival calculus, perio probing around it is almost impossible or misleading.
Going immediately to SRPs will certainly lead to a denial. Just another roadblock and hoop that
the insurance company requires us to jump through. ■
8/24/2019

Practice Whisperer
Member Since: 07/22/11
Post: 42 of 58

I am not sure where you heard that myth, but it just flat has no truth to it at all. We do
around 300 SRPs a year, maybe 1-2 FMD. We might have two to three denials a year on SRP,
and typically those are cases we already had the patient prepay in full since we can usually tell
upfront what will and will not be approved.
Doing anything with insurance is purely about knowing what they want to see to approve
a claim. Provide that and you fi x 90% of your issues. The other 10% is just the annoying delay
game they play. ■
8/24/2019

How do you handle making claims
with your insurance company?
No one likes dealing with obstacles when it comes to providing
the best care for your patients and minimizing the financial
burden through insurance. Sometimes, however, it's inevitable.
What have you done in a situation like this? If you'd like to read
the entire message board and read, or give, more advice, view
this message board online at dentaltown.com/magazine.

DECEMBER 2019 // dentaltown.com

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Dentaltown December 2019

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