Dentaltown October 2022 - 20

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SRP Being Denied
Townies open up about insurance coding and the future of SRP treatments
ranishina
Member Since: 04/09/09
Post: 1 of 35
My offi ce manager is telling me that insurance companies are playing games and denying more
SRP. They want to see bone loss. So we need to wait until there is irreversible damage. All other
indications don't matter anymore? This includes Delta now. How are you guys handling this? ■
8/24/2022
Timmy G aka Nowhere Man
Member Since: 04/14/02
Post: 2 of 35
Giacomo _ Tarquini_DDS
Member Since: 09/11/07
Post: 6 of 35
There are many companies absolutely not budging off the " must have visible bone loss. " One
of the reasons I'm doing less SRP in my offi ce. If I think it's going to be next to impossible to get
payment, off they go to a periodontist. ■
8/24/2022
Hate to say this, but from a strictly scientifi c point of view, insurance companies are right.
According to the AAP defi nition, periodontitis is an " infl ammation of the periodontal tissues
resulting in clinical attachment loss, alveolar bone loss, and periodontal pocketing. "
Because SRP represents the elective therapy for periodontitis (Drisko, Periodontol 2000,
2001) and because, in turn, periodontitis is characterized by alveolar bone loss, it's not wrong to
request PAs (and I would add periodontal charting) to objectify the disease state.
To summarize: no bone loss = no periodontitis = no SRP. ■
8/24/2022
fl uoridefreebacon
Member Since: 05/11/15
Post: 7 of 35
Insurance companies are cracking down because SRP was abused by a lot of dentists and
corporate places. I have temped in offi ces where the hygienist has to " fi nd " a certain percentage
of SRP (usually 40% to 50%). This was tied to bonuses and production, so naturally the probe
got pushed a little harder in. I am not accusing you of fraud, of course, but that is what is
happening in many offi ces to make up for PPO fees they agreed to.
If there is no bone loss but a lot of infl ammation, then the proper code is scaling in presence
of infl ammation. You can still bring the patient back for a prophy, but insurance may or may not
cover. (Patient would be responsible even if PPO provider.)
I hate insurance companies as much as the next guy, but they are following what the ADA
codes and the American Academy of Periodontology state as their defi nitions.
So, bottom line: It is not SRP until there is bone loss. You still can treat the patient, but it is
coded as either scaling in presence or prophy. With proper home care and removal of calculus, they
should not advance to periodontal disease. If they do, then you can do SRP at that time. ■
8/24/2022
Drfi shandgame
Member Since: 04/16/22
Post: 10 of 35
Timmy G aka Nowhere Man
Member Since: 04/14/02
Posts: 14 and 15 of 35
As I understand it, that's what the D4346 code is for. ■
8/24/2022
This may not be of any help to you, but in the situation you describe (trouble but not yet
bone loss), I explain to the patient that their mouth is not healthy but I think there is a decent
chance we can prevent it from getting worse or to the point of needing more extensive treatment.
To do that, one visit isn't going to get it done, we're going to need a couple. In my offi ce, we
call it a " two-visit prophy. "
20 OCTOBER 2022 // dentaltown.com

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