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How long to wait to SRP after prophy?

This mainly applies to existing patients at a practice. Say you’re seeing a patient for his/her 6mrc and they end up needing SRP. Typically, I will do the prophy then bring them back for SRP on a different day. However, I’m told that with some insurance companies, if you do SRP the day after a prophy, insurance won’t cover it. Sometimes you even have to wait 3 months after a prophy to do SRP. I’m told it’s best to just reschedule the patient for SRP then do the prophy after if need be. Does anyone have more info about this? Mainly insurance info? For example, with Delta, I’m told that the insurance company won’t cover SRP until 3 months after a prophy.

I would like to know if anyone has any details about this. I would like to make sure I’m doing my job correctly!



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3 Answers

In the office I work in, we do not do SRP right after a prophy. If the patient needs SRP, we do that first, so we are getting everything removed from the pockets, then we have them come back to the office in 6 weeks for a re-evaluation which consists of re-probing, and basically doing a perio maintenance appointment. I clean everything with the ultrasonic, hand scale, polish, and floss. After the 6 week re-evalution (which is considered a Perio Maintenance 1 for insurnace), we determine how often of a perio recall we need, whether it be 3,4 or 6 months.
Are you only scaling supra at the prophy cleaning? I had learned in school, you don’t want to scale supra, then wait an extended period of time before scaling sub because there is a chance the gingiva could heal and trap the calculus below the tissue. I have always heard to clean sub before supra, unless you are having to clean the supra in order to even do an evaluation of the teeth due to calculus being so heavy. Even then, I was told you want them back in soon to clean all the sub-gingival calculus.
Hope this helps!

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I’m looking for more insurance based answers, but thanks. The reason being that the practice I work for wants me to do something while the patient is there aka a prophy THEN bring them back a later day for SRP. My question is, in accordance with insurance, how long do I have to wait after a prophy until SRP can be done? I would like examples of possible… Delta, United Concordia, BCBS, etc.

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I am in complete agreement with what rhayesrdh commented with. You want to be careful billing a prophy then turning around and billing SRP because technically a prophy is a preventive procedure, in which the patient does not qualify for if they have active periodontitis. Doing it just to bill or to “do something while the patient is there” can be seen as over-treating which could possibly lead to insurance fraud issues. Also, the patient may not come back for the treatment that is actually needed because they received “a cleaning” and further was billed for it. Not to mention, tissue healing around remaining calculus which could lead to such problems as perio abscesses.
 
Regarding specifics about insurance company policies, it’s best to contact them directly to get the most accurate info. Policies can differ depending on which plan a patient has, so getting specific requirements may depend on the patient’s individual insurance plan. It’s always best to verify insurance before a patient has even sat in the chair.

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