Question

Can we perform one or two quadrants of SRP (D4341) and a prophy (D1110) on the same day if that is all the root planing that is needed?

This is a common question. The descriptor for D4341 states, “This procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces…” For this reason, many carriers have programmed their computer systems to deny D1110 when performed on the same day as D4341. While this policy may make sense when all four quadrants require D4341, it does not take into account the fact that some quadrants may not require SRP and may only require a prophylaxis.

While some carriers will reconsider payment for the prophylaxis of the uninfected quadrants upon appeal, others will not. When this is the case, from a reimbursement perspective, many practices have found that it is best to do the prophylaxis on the uninfected quadrants during the first visit and re-appoint the patient to perform SRP on the diseased quadrants on a separate date. This allows the clinician time to inform the patient about the periodontal disease process and obtain consent to treat the bacterial infection at the next appointment in order to avoid further bone loss and reduce the risk of other health complications.

Note that some plans include a time limitation between any SRP and prophylaxis, regardless of the order in which the procedures are performed (i.e., 30, 45 days, etc.). Also, some PPO contracts include a similar time provision (refer to your PPO Processing Policy Manual for clarity). 

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