Evidence Necessary for Scaling and Root Planing
Documenting the dental claim
*This document does not address policy manual provisions and limitations imposed by each plan that may deny a claim regardless of accurate clinical documentation)
What is PSRP/SRP
Periodontal scaling and root planing, per quadrant involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic in nature. Root planing is the definitive procedure designed for the removal of cementum and dentin that is rough, and/or permeated by calculus or contaminated with toxins or microorganisms. Some soft tissue removal occurs. This procedure may be used as a definitive treatment in some stages of periodontal disease and as a part of pre-surgical procedures in others.
Classification of periodontal condition (class II, III, IV) by the dentist or hygienist must be in the chart and indicated on the claim.
It is anticipated that this procedure would be requested in cases of severe periodontal conditions (i.e., late Type II, III, IV periodontitis) where definitive comprehensive root planing requiring local/regional block anesthesia and several appointments would be indicated.
From the American Academy of Periodontology (AAP) Policy on Scaling and Root Planing: “Periodontal scaling is a treatment procedure involving instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces. It is performed on patients with periodontal disease and is therapeutic, not prophylactic, in nature. Periodontal scaling may precede root planing, which is the definitive, meticulous treatment procedure to remove cementum and/or dentin that is rough and may be permeated by calculus, or contaminated with toxins or microorganisms. Periodontal scaling and root planing are arduous and time consuming. They may need to be repeated and may require local anesthetic.”
Periodontal scaling and root planing (D4341/4342)1 is distinctly different from a dental prophylaxis (D1110)1 and scaling in the presence of generalized moderate or severe gingival inflammation (D4346, effective January 1, 2017).2 Prophylaxis is a preventive procedure and is performed on patients with a generally healthy periodontium, or on patients with localized gingivitis. Scaling in the presence of generalized moderate or severe gingival inflammation is indicated for patients who have generalized moderate to severe gingival inflammation, with or without pseudo-pockets but exhibiting no bone loss or loss of attachment. Key to scaling and root planing is the instrumentation and removal of deposits from the root surfaces of the tooth.
The following diagnostic documentation is needed to support the delivery of scaling and root planing and must be included on the claim:
- Periodontal charting that records pocket depths, including 6 points per tooth, and bleeding on probing. (pockets depths alone are not enough to prove need of PSRP/SRP) (generalized 4-5-6MM)
- Full-mouth radiographs or digital images (of excellent quality, showing bone loss and calculus on tooth surfaces)
The diagnostic materials must demonstrate the following:
- Clinical loss of periodontal attachment
- Radiographic evidence of crestal bone loss or changes in crestal lamina dura
Bone loss must be evident on the radiographs to justify the presence of calculus and bacterial deposits on root surfaces.
Scaling of calculus and bacterial deposits from enamel surfaces, whether supragingival or subgingival does not constitute root planning because it does not include loss of bone or attachment.
- Radiographic evidence of root surface calculus
The above documentation should be retained in the patient’s dental record and provided upon request of dental insurance company.
D1110 – prophylaxis – adult
D4341– periodontal scaling and root planing – four or more teeth per quadrant
D4342 – periodontal scaling and root planing – one to three teeth per quadrant
D4346 – scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation. Effective January 1, 2017
40804 Removal of embedded foreign body, vestibule of mouth, simple
41899 Unlisted procedure, dentoalveolar structures
ICD-10 Diagnosis K03.6 Deposits [accretions] on teeth
K05.1 Chronic Gingivitis
K05.30 Chronic periodontitis, unspecified
Z72.0 Tobacco use Z91 Personal Risk Factors, not elsewhere classified
I am baffled by the inclusion of radiographic calculus on the root surface as a necessary component for SRP claims. Calculus on the root surface is nowhere in the definition of periodontal disease, per the American Academy of Periodontology. You are correct, insurance companies demand it, but why? I have had claims denied for LACK of this evidence. (FYI, I have taken a dispute package to the California Dental Association regarding the worst offender in SRP claims processing, Principal Insurance). This office is in patient advocacy mode!