Question

How often should a full periodontal charting be performed on an adult patient, and what code should we report?

If your definition of a “full periodontal charting” means a complete recording of pocket depths, recessions, furcations, mobilities, bleeding points, minimally attached gingiva, etc., then the American Academy of Periodontology (AAP) recommends performing a complete periodontal charting at least once a year. Personally, I probe all pocket depths each time I see a patient to assess changes in pocket depths, tissue tone, extent of plaque, deposits, etc., but I only perform a complete charting once per year. The exception would be the patient whose condition changes drastically in a short time. For example, if there is a 4 mm reading on the facial of tooth #30 on one visit and a 7 mm pocket in that area six months later, then something has changed significantly, so I reprobe and record everything.

With regards to coding, if a complete periodontal charting is performed at the time of a comprehensive evaluation on a new or established patient, it is considered part of the evaluation and reported using D0150 (comprehensive oral evaluation–new or established patient). However, if the patient has signs or symptoms of periodontal disease or risk factors such as smoking or diabetes, then the complete charting and evaluation should be reported as D0180 (comprehensive periodontal evaluation). Both D0150 and D0180 require the evaluation and recording of the patient’s dental and medical histories and a general health assessment. They also typically include the evaluation and recording of dental caries, missing or unerupted teeth, restorations, occlusal relationships, and oral cancer screening. According to The CDT Companion, published by the American Dental Association in 2007, the primary difference between D0150 and D0180 is the requirement that patients must have signs or symptoms of periodontal disease in order to report D0180. Both codes can be used by general dentists and specialists, and carriers often pay them similarly.

By: Kathy S. Forbes, RDH, BS (August 2008)

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