How do we code Radiographic Bone Loss


I did have a question I did not feel that I clearly understood after it was discussed. If we get a new patient who has a history of perio, or maybe even has perio but has only been recieving D1110, if they present with radiographic bone loss (significant or slight) but probe depths are 1-3 with no BOP…how do we code the care we are providing? I often get a Pt who now has new insurance,  can’t remember when they last had SRP but they have had tx and are now stable…if I can’t charge for perio maintenance then do I still charge D1110? I’m not sure what to do about this because we ARE maintaining perio but don’t have record of the SRP.

Patti Response:

Great question and not as simple an answer as we would like. What is the diagnosis? That is the answer to every coding question. A new patient should be seen by the dentist, at least on a quick level, before any kind of treatment is done. What needs to be determined is their current state of health. There should be no ‘automatic’ prophylaxis performed. A prophylaxis is the treatment of choice for patients with <30% inflammation in the absence of periodontitis.

In the absence of periodontitis is the key phrase. How is that determined? Unfortunately, we have traditionally been depending on pocket depth and bone lost. Bone loss is not necessarily a current condition. Pocket depth alone is a single parameter that is part of the diagnostic process.

As far as ‘charging’ that is different question from accurate coding. If there is no documented history that you have a record of surgical or non-surgical perio treatment, the D4910 cannot be used. Let’s let at the definition of the code: This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements.  It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing where indicated, and polishing the teeth.  If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.  

Again, if you have no record, you can’t use the code. If the person is stable with a reduced periodontium, then the determination is greater or less than 30% inflammation. >30% then D4346 is the treatment. If <30% then D1110.

I invite you to join my DentalCodeology Insiders group. We are proactively submitting for new and revised codes as well as lobbying to get an RDH on the codes committee. Until RDH have a vote, our voices won’t truly count. We need a larger voice and would love to have you join us. I think rubbing elbows on a similar journey can help to learn more too.

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  • This was a great explanation for a complicated question. Thank you for helping it make sense.