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new patient, previous perio hx, no bleeding

I’m a recent hygiene grad and I feel like I see this often now that I’m in private practice and I’m unsure of how to hygiene treatment plan this…

What do I do for new patients who have periodontal disease but present with a stable periodontium? For example, there’s no pocketing above 3mm, no bleeding, but severe loss of attachment?

In every case so far, the patient has been unable to obtain history of their initial scrp from an office that I could submit to insurance to justify coding my service as a perio maintenance.

Any other ideas or advice would be so helpful!



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2 Answers

I will inform the patient they have peridot al disease but it is under control. If there is no BOP, no gingival inflammation, only 1-3 mm pockets and teeth are really clean (OH is good) I will code as prophy for the first visit. I stress importance of continuing recalls to prevent needing a SRP again or relapse of the infection. I explain they are in a good state orally now but that the bone can start to recede more if OH and recalls are not kept up.

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The hardest part I find of practicing is to not allow insurance to dictate your treatment. Radiographic evidence of bone loss & gingival attachment loss are indications of periodontal disease. Bleeding is an indication of active disease vs not. In regard to insurance, try submitting a narrative explaining the history of srp with unaquirable dates(can require patient contact office where tx was done), with radiographic evidence of attachment loss. It requires a lot more work with insurance. Best thing is to explain the periodontal condition to the patient & that you are filing their insurance as a courtesy which can require them to contact previous offices or insurance companies to obtain dates! No you can not look into the information for them as INS will not give an office that info & previous offices will want a release filled out (unless you want to go to this extent) Don’t code a prophy as that’s what the insurance company wants you to do… Take the easy route for less $$. Just a few things I have found helpful in obtaining property treatment and collecting the correlating fee! Good luck!

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