When to Bill D4355: Gross Debridement

Welcome to Tuesday Tips with MODPractice!

This week’s tip: When to Bill A D4355?

What do you do in this scenario? The patient’s last cleaning was 5 years ago and unfortunately, this patient doesn’t have the best homecare so there is a significant amount of plaque and calculus.

Due to the amount of calculus, it would be impossible to get accurate measurements for periodontal charting and the amount of calculus present makes it extremely difficult for the doctor to perform a comprehensive exam.

So, what do we do? 

D4355: Full mouth debridement involves the preliminary removal of plaque and calculus that interferes with the ability of the dentist to perform a comprehensive oral evaluation.

Can you bill D0150 on the same date of service?  NO!

A full mouth debridement is completed in order to be able to perform a comprehensive exam and is NOT to be completed on the same day as D0150, D0160, or D0180. If your patient presents with this type of condition, you will need to reschedule the patient for a comprehensive evaluation 10-14 days after the gross debridement is completed to allow for healing. 

But, you need to actually examine the patient in order to diagnose the need for the D4355 so what can you bill on the same day? 

D0191: Limited clinical inspection that is performed to identify possible signs of oral or systemic disease, malformation, or injury, and the potential need for referral for diagnosis and treatment.

Supporting documentation must include: a detailed narrative utilizing a SOAP note template, FMX or Pano, and intra or extraoral photographs clearly showing the amount of plaque and calculus.

Please keep in mind that even if you jump through all of the hoops, this is not a guarantee of coverage.  Best practice is to thoroughly review the treatment plan with your patient and ensure they sign a financial agreement that reinforces the fact that the patient is responsible for the cost of their treatment regardless of whether or not the insurance company decides to cover the treatment they need.

Interested in learning more about Revenue Cycle Management for your practice? Contact us today!