{1 - 24} GreyGrey
{25 - 49} GreenGreen
{50 - 499} BlueBlue
{500 - 4999} OrangeOrange
{5000 - 24999} RedRed
{25000+} BlackBlack

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Periodontal Maintenance and insurance

If the hygienist is doing a periodontal maint. and the patient’s insurance provided insurance coverage 2X/year and the patient is on a 3-4 month recall. I have been told that the at the patient’s 3rd PM for the year that you would bill D4910 but in the insurance notes ask the insurance company to apply alternative benefits. Does anyone do this or what is the protocol and this. I know you cannot alternate between a 4910 and 110. Also if this can be done does insurance pay?



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3 Answers

We include a narrative to all 4910 claim that reads, “If periodontal maintenance (D4910) is denied, please provide the alternative benefit of prophylaxis. The ongoing periodontal maintenance visit included prophylaxis (D1110).”

RDH mag did a great article on this in Feb 2014, which includes info about the above narrative.

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You can always add a narrative to any dental claim…..sometimes you’ll get lucky. Most insurance are changing their benefits and allowing 4910 4 times yearly at a basic percentage with a yearly deductible. Some companies are offering 3 adult prophies yearly too along with no age limits on topical fluoride treatments. I’ve only had a few pt not really want to pay out of pocket once or twice a year for 4910. It’s not our fault they have periodontal disease. Most pts do not have a problem paying out of pocket a couple times a year as this is thoroughly explained to the pt before any S/RP is completed.

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This is what we are dealing with in our office as well. Insurance Solutions is stating to do this and you may get coverage but you still chart a PM and code a PM with a narrative.

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