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Perio Protocol

I’m a recent grad and I’m still having a hard time with insurance codes. My office has a “perio protocol” that we follow and I’m just wondering if this is something all offices do, and also want to make sure this is the RIGHT way to do it. These are the steps we take for a new pt:

Pan or BWX
Definitive probe
Asses perio status:
If healthy – 1110
If moderate gingivitis – 4346
If heavy calculus – full mouth debridement followed by fine scale (no boneless) If there is boneless, SRP where necessary followed by perio maint

I want to make sure I’m doing the right thing legally and ethically. I’m also really curious to know if other offices follow a similar perio protocol



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2 Answers

Many offices do have perio protocols. Not all offices do things exactly the same, there’s always variation. Just like with patient treatment, there’s no “cookie cutter” way that works for all.

-Most offices I have worked at do a full mouth series of radiographs for new patients.
-When perio charting: depths, recession, bleeding, furcations, mobility, etc. are all documented.
-Offices I have worked for, new patients are seen by the doctor first, not the hygienist. Check your state’s Dental Practice Act or contact the State Board to make sure this isn’t required in your state. Even if its not a specific requirement by the Board, you have to remember that hygienists don’t diagnose (besides a dental hygiene diagnosis). Because of this the need for radiographs, etc. must be diagnosed by a doctor who has examined them before you treat.
-Full mouth debridements should only be done if there’s so much plaque/debris that the doctor cannot do a proper exam. If they need a prophy, gingivitis treatment, or SRPs, its best practice to just do that and skip the debridement.
Just my experience!
 
Here are some links that may be helpful:
http://jdh.adha.org/content/82/suppl_2/16.full.pdf
http://www.drotterholt.com/pseudopockets.html

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In my office, we have new adult patients see the doctor first for a comprehensive evaluation/exam. At that appointment, we take a CT scan, 4 BWX, all existing restorations and decay are charted, perio probing done (charting all pocket depths, recession, furcation involvement, BOP, and mobility), and have a discussion with the patient. From that, a diagnosis of the perio condition is made by the doctor and the type of cleaning is determined. We will do a standard prophy (1110), the gingivitis code (4346), or a SRP where needed. We don’t do a full mouth debridement due to it only being recommended if the doctor isn’t able to do the exam due to excessive build up. We also don’t do a fine scale.

If we have a perio patient that needs SRP, we will do the SRP, then do a Perio Maintenance appointment in 6 weeks to re-evaluate the period condition and determine the recall of 3, 4, or 6 months. We do probe readings at each Perio appointment. We typically do Perio measurements every 6 months even for a 1110 prophy. If the patient has all healthy pocket depths and little or no BOP, we will do probing once a year.

Hope this answers your question!

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