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Periodontal processing tips
Periodontal surgery cases
These cases require
the completion of the tooth chart on the claim.
Please circle the surgical area and place an "X"
over missing teeth.
Periodontal root planing
For periodontal root
planing (procedure 04341), do not enter "FM"
to indicate "full mouth" in the tooth
number area. Please use one line of the claim for
each quadrant and enter a separate fee for each
quadrant. Also, the span of treatment to complete
all quadrants of root planing should not exceed
three months, unless special circumstances are documented.
Periodontal procedures 04270
(soft tissue graft) and 04271 (free soft tissue
graft, including donor site) are payable per tooth.
Please be sure to report these procedures using
a separate line for each tooth on the claim.
Guided tissue regeneration
(04268) is chargeable separately from osseous
surgery (04260). When submitting claims for these
services, please list guided tissue regeneration
on a separate line from the quadrant(s) of osseous
surgery, and indicate a separate fee.
Osseous surgery (procedure
04260) does not include extractions, removal of
exostosis, apicoectomy/periradicular surgery or
retrograde filling, root amputation, hemisection
or bone replacement grafts. These services are
chargeable separately.
Crown lengthening
This procedure (04249)
is a benefit only when it includes soft and hard
tissue and is the only periodontal procedure that
requires submission of an x-ray. A distal wedge
procedure is not considered crown lengthening. A
radiograph and narrative are required documentation
for crown lengthening procedures.
General periodontal tips
Complete periodontal
charting includes notation of pocket depths, recession,
furcation involvement, mobility and mucogingival
defects.
Allowances for periodontal
maintenance (procedure code 04910) include any
examination on the same day.
A quadrant is defined as
including at least four diseased teeth. Allowances
are based on a portion of the fee if there are
fewer than four teeth involved in a quadrant for
procedures 04210, 04240, 04250, and 04260.
A site is defined as up
to two diseased adjacent teeth that may cross
the midline. Allowances are usually limited to
two sites per quadrant for procedures reported
by site, including 04249, 04263, 04264, 04268,
04270 and 04271.
Back
to claims processing tips index
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