Today, we're going to delve into two key dental procedure codes: D1110 and D4910. Understanding these codes can help you handle billing procedures more accurately and efficiently, ultimately benefiting both your dental practice and your patients.
The D1110 code is used for an adult prophylaxis visit. This dental procedure code refers to a routine dental cleaning, which includes the removal of plaque, calculus, and stains from the tooth structures above the gumline. This service is typically performed for patients who are 14 years old or older and show no signs of deep pockets or periodontitis.
It's essential to note that D1110 and D4910 are not interchangeable. If a patient has a history of periodontal therapy such as scaling and root planing, ongoing periodontal maintenance visits, or osseous surgery, D1110 should not be used. Incorrectly swapping these codes could lead to reimbursement fraud.
In addition, there are some insurance plan limitations associated with the usage of D1110. For instance, this code typically gets 2 per calendar year payments. The carrier may pay for two appointments now with no benefits for the rest of the year. Another limitation may be 1 per 6 consecutive months, with one payment being made every six months. This means a complete six-months must pass between each D1110 procedure for benefits to apply. Furthermore, the patient could also have a 1 per 12 consecutive month limitation. This means 12-months would need to surpass from each D1110 charged for that period. For example, D1110 completed 2/01/2023 would need to be completed 2/02/2024 and D1110 completed 8/02/2023 would need to be completed 8/03/2024 in order to receive benefits.
On the other hand, the D4910 code is used for periodontal maintenance. This procedure is performed following periodontal therapy and continues for the life of the dentition. It involves plaque and calculus removal from supragingival and subgingival regions, teeth polishing, and site-specific scaling and root planing.
However, benefits for this procedure are often denied because many carriers have limited benefits for this procedure. Some carriers may only allow benefits for this procedure if two or more quadrants have received prior therapy. Moreover, it's important to note that most payers require a waiting period of 8 to 12 weeks following periodontal therapy before reimbursing for D4910.
If the periodontal maintenance is reported and denied, some payers will allow payment for an adult prophylaxis (D1110) to provide some level of coverage for the insured patient. To minimize claim denials for periodontal maintenance, provide documentation with the original claim submission if there are unusual circumstances in the patient’s case.
In the world of dental billing, accurate coding is vital. Understanding the difference between D1110 and D4910 can help ensure that your dental practice is billing correctly for the procedures performed, leading to better reimbursement for your practice and clearer communication with patients about their treatments.
Remember, D1110 refers to a routine cleaning for patients with healthy gums, while D4910 is for patients who require ongoing periodontal maintenance following periodontal therapy. Always make sure to use the appropriate code based on the patient's dental health status and history to avoid any potential issues with insurance reimbursement.
Please note that this blog post is current as of May 2023 and the guidelines may change. Always refer to the most recent ADA guidelines and payer processing documentation, or consult with your dental billing company for the most accurate and up-to-date information.
This blog post is for informational purposes only and does not constitute professional advice. Always consult with a dental professional or billing specialist if you have any questions or concerns about dental billing and coding.