{1 - 24} GreyGrey
{25 - 49} GreenGreen
{50 - 499} BlueBlue
{500 - 4999} OrangeOrange
{5000 - 24999} RedRed
{25000+} BlackBlack

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Do you have any suggestions or know of an ADA code for “hard prophies?”

My dentist used to allow us 1.5 hours for a harder prophy (whether it be due to heavy stain, plaque, or calculus) but is now wanting to cut all prophy a to 1 hour. I had heard there was an ADA code for a “hard prophy” (not perio maint but instead for a 6 month recall that needed longer time) that would charge more for a prophy, but i have been unable to find it. I feel that if there was a way my dentist could make more money on these 1.5 hour “hard prophys” that he wouldn’t make us cut back our time with them to one hour. I would hate to cut down the time on these harder cleanings because I feel I would not be able to remove all stain and calculus. Would u happen to have any suggestions or know of an ADA code for “hard prophys?”



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5 Answers

I am unaware of a “harder prophy” code. This is what SRPs and perio maintenance are intended for. I would show these patients the calculus, plaque, and stain with a hand mirror, explain to them what their perio charting means, go over brushing/flossing technique and tell them at their next visit you will need to re-evaluate if they need SRPs and get them on perio maint. Sometimes patients will up their home care just by being shown what’s in their mouth. I would also tell them that they are swallowing all of this bacteria and it can cause other issues in the rest of their body (higher risk for heart disease, etc.). Don’t forget to tell them that this bacteria can also cause the breakdown of their gums (gingiva doesn’t grow back!) and eventually the bone that holds their teeth in! I find that if patients actually see what’s going on and know that they will have to go through a “deep cleaning” they tend to step up their home care. And if they don’t, they will need to come in every 3-4 months, which will make your job easier if they are on this shorter recall, and an hour should be adequate. And don’t forget your ultrasonic! Even on a lower power it removes stains and can knock off the big stuff much easier than hand scaling! If the patient is too sensitive, than that is another reason they need SRP’s and need to be anesthetized!

 

I find in a lot of offices more patients should be in a perio program than actually are. It’s better care for the patients and when the billing and coding are done correctly your time is being compensated more efficiently.

 

Now, with that being said, if their perio charting is healthy (not sure how it could be with a mouth full of plaque!) you could always put them on a shorter prophy recall. Their insurance may not cover the extra prophy per year and may be out of pocket, which may make them step up their home care as well. If all else fails, if you don’t finish in an hour, tell them you can’t finish due to the condition they are in (explain perio charting and all that to them) and they need to reschedule and come back (which most likely will be out of pocket as well). You can only do what you can do, but its not worth doing a partial job just because you don’t have enough time. Don’t forget to chart all of this like crazy!

 

I hope this helps and good luck to you!

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I remember seeing a code once when I was in hygiene school that was for a “difficult prophy” that was separate from the usual 1110, 4341, and 4355 codes but now I can’t find any information on it. Maybe the ADA deleted the code? All I can find now is either use the 4355 code for heavy supra/stain, or use the 1110 code but charge more than the regular fee along with an explaination, or there is a 4999 code for “unexplained perio condition” whatever that means. But that code needs alot of explaination and usually still doesn’t get covered by insurance.

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Correction. 4999 code is for unspecified perio procedure not condition. That code seems to be for patients with substantial calculus and inflammation (meaning not healthy so not an 1110 preventative cleaning) but no bonw loss so not SRP for perio. Its more of a gingivitis with calculus build up cleaning that takes longer than an 1110. I have never used this code before and I don’t know of anyone who has so my guess is it hardly ever gets used but it is an option.

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I can double check on this tomorrow when I go to work but I believe one of our insurance gurus at my office had told us about a D9998 or D9999 code that you could use for extra time. I believe that for an extra 20 min we charge ~$40 (so $20/10 min extra). I have only added this on a few patients with their acknowledgment ahead of time – when I am scheduling their next recall appt.

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I would try to place the patient on 3-4 month Adult Prophy and they will have to pay out of pocket for two a year. Those two extra a year will not have the exam or radiographs and most patients are fine with it. Especially if they can’t improve their home care. I’d give them disclosing tablets that turn old old plaque blue and newer plaque red. Tell then to brush three times a day and dry brush once daily (dry brushing if done correctly takes anywhere from 5-20 minutes) until their teeth taste and feel clean.

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