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Full mouth debridements

I know this has been discussed before but I wanna ask for thoughts on debridements…do u use code D4355, when, how long before you see pt back, do you wait for comp exam/perio eval until pt returns? I know quite a few have mentioned debridements not recommended or taught in school and never to do them. Please tell me why. I’m debating about debridements & want feedback. Thanks



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2 Answers

I consider 4355 as a gingivitis code which I call Intial Periodontal Therapy (IPT 4355) with a follow up Adult Prophy 1110 in 6-8 weeks. However, in rare cases when pt is back in 6-8 weeks and during probing if the depths are deeper than before then I educate about S/RP and that is the next step….Insurance will deny S/RP if an Adult Prophy was completed 6-8 weeks earlier which is the reason I code IPT (4355) because I can go directly to S/RP or Adult Prophy. Some gingivitis pt can have 5-6mm without bone loss. That is why I always measure any + or – gum margins. 6mm PD with -2mm AL is 4mm pseudo pocket. Most insurance only pay 4355 once per lifetime and I explain to pt that they may have to pay out of pocket for their deductible plus 20% and I tell them the $$ amount. I tell them if an Adult Prophy is what is needed in 6-8 weeks that insurance should cover that. Then I proceed to let them know how much 1,2,3,4 quads of S/RP is and how much Out of pocket will be for that. Most of the time I know the pt will need IPT then Adult Prophy, but I want them to be aware of any and all that could happen so there aren’t surprises. If I truley have a pt that needs S/RP and very heavy supra ginigval calculus I will never do a 4355. I will instead plan S/RP and have doctor do Comp or periodic exam and then once S/RP is complete have doctor back in to re-eval previous exam…..I do not charge another exam. Hope this helps.

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If a patient has bone loss, BOP and sub and supra calc, SRP would normally be treatment of choice. This normally can even be diagnosed sans complete period charting as you can get those numbers more easily when the patient is numb. Of course it is ideal to have them prior.
So, the only clinical justification I have ever heard for doing a debridement is to remove the supra calc to get down into the pocket. Many times there will still be sub calc in the way, so I don’t agree with this justification. The only reason left that I can see then is a “practice builder”. If a practice is only doing it for the bottom line because insurance happens to cover it, I say no thanks.
Removing just the supra calc can cause the gingival margins to tighten up essentially closing off that pocket with calc and bacteria remaining…this is just inviting a perio abscess to occur. Also, more often than we would like, patients are happy with the visible, supra results and don’t return for the SRP.
The best treatment with the best outcome regardless of the cost, is what I feel we need to offer our patients.

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