Q&A: D1110 vs D4910

Q: Do we use D1110 after D4341 or D4342? Of course, I always tell people that following is a periodontal procedure; we should be doing periodontal maintenance, D4910. But this one team wants to do the first follow up as a “fine scale” using the D1110 and then all of the subsequent appointments will be periodontal maintenance. Is that correct to do? Will it adversely affect the subsequent filing of D4910? Also, do you file D4910 after a D4342 procedure? Some say yes some say no….it was my understanding that we do following all periodontal procedures. 

A: What the challenge is here is not coding, it is the lack of diagnosis. Codes are generally considered somewhat ‘bass-awkwards’. What I mean is, if there person has been treated with D4341 or D4342, what was the diagnosis? What is being treated? To be honest, there is no ‘always’ with coding. If there person had a documented diagnosis-as required by our evaluation codes, this would all be clearer/ 

What kicks is the D4910 code is documented non-surgical or surgical periodontal treatment. There is no language in coding on how much. In other words, if there has been non-surgical treatment of 1-3 teeth, the person then qualifies under the CDT definition. 

I emphasize ‘documentation’ because see that the person has bone loss and tells you they had ‘deep cleaning’ or some of other awful term does not qualify. A record of the dates is needed. 

There is no periodontal literature, nor has there been for many years, that supports the gross scale/fine scale philosophy. D1110 is not a code for ‘fine scale’. Just using that language shows the inadequacy of understanding of the current literature by that office. 

As far as how something is filed adversely affecting future coding is not a coding question. What is mixed up here is coding with coverage. Using codes in a specific just to increase coverage could be considered fraud. We need to accurately code, a carrier may remap (up or down code) but an office cannot. The reason they can is a clause often in contracts called LEAT-Least Expensive Alternative Treatment. A carrier can do it but we can’t because when we ‘play around’ so to speak with codes to increase benefit, we fall into coding for something we did not do as it appears in this case. 

Let me explain why the ‘always’ D4910 isn’t accurate. The ADA was asked if anyone could return to D1110 after D4910. Their response was if ‘in the opinion of the treating DDS, there is sufficient healing’ then they can return to D1110. What can’t be then used is to go back to D4910. 


Comment below with thoughts or questions!

–The DentalCodeology Team


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