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I know that perio maintenance d4910 includes localized srp. But to what extent? I had a pt in last week that had four full quads of srp 1 year ago and never came back for maintenance. When she came in recently she had 4-5 mm in posteriors with mod-heavy sub calc. Would this type of cleaning be included in the d4910? Or , bring pt back for srp 1-3 (d4343) in all quads?



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3 Answers

If there is active disease, which it seems there is, you treat the disease. To treat the disease, SRP (localized, if indicated) seems appropriate to me. This just does not appear to be “maintenance (4910)” with 4-5 mm pockets and mod-heavy sub calc. However, Sue Halverson is correct in that insurance may not cover it so soon. But it’s not your fault the patient was non-compliant; you can only treat what you see. Has anyone verified the patient’s insurance benefits? That would be my first suggestion! To perform a perio maintenance borders on the line of supervised neglect. Think about it this way; if this patient went to a different office as a new patient, they would diagnose active perio and recommend SRP. When they verify insurance they would be in the same position you are, but I still bet they’d recommend SRP. Remember, treat the patient and the level of disease you see at the current time/appointment, using your education and what you know is best for the patient, not what insurance covers.

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I hate to say it, but the treatment might be dictated by what insurance says. Most I insurances will only pay for SRP every 24 months. That being said, I personally would push for localized SRP since the clinical evidence supports it and the patient has not been compliant. If a patient ends up needing more comprehensive treatment again, they might be more apt to come in on a more regular recall for the PM. I stress the word “might” though, they may also be more apt to not come back at all. Tooth call. Good luck.

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I agree with Kara and Sue. If the pt is going to let insurance dictate you may have to do GD until you can do SRP again. Also, be sure to EDUCATE the pt on perio and need for more frequent recall!

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