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NP cleaning diagnosis with LOA

I have had a ton of new patients that present as an AAP III but with no active disease. When asked if there was a history of SRP they say no. What would you do for a cleaning and bill out? It is my understanding that if you do SRP, it may cause further attachment loss and they are not technically a prophylaxis because of the history of disease.

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1 Answer

For a more definitive answer on whether a patient has previously undergone non-surgical periodontal therapy/SRP, you can call the patient’s insurance company instead of relying on a patient’s memory. If they have, you can bill D4910 (perio maintenance). Otherwise, billing D110 is appropriate, even though it doesn’t seem like it. There’s no need to do SRPs if a patient doesn’t have active disease and are periodontally stable. That could be considered over-treating. I don’t recall ever being taught or reading that SRP causes further attachment loss. If scaling caused attachment loss, we wouldn’t do it! Coding can get really confusing especially when a patient has a history of periodontitis, has never had periodontal therapy, yet is stable now. To sum it up, treat what you see today using your best clinical judgment. There are some good coding books out there like DentalCodeology by Patti DiGangi, RDH, BS, and Coding with Confidence by Charles Blair, DDS that may be really helpful.

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