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Hygiene Codes

Picture this: your hygienist has a full day of patients.  A couple of S/RPs, a couple of new patients, and some nice recalls.  Ahh… it’s a beautiful thing.

But wait!  What’s that I see here?  She hasn’t been using the correct CDT codes for her procedures.  Oh no!  Poor coding is about more than just lost revenue; it can lead to benefit claims bouncing back and over- or under-treatment.

We should periodically sit down with our hygiene teams and discuss treatment philosophies, like when to refer to a periodontist or how often a full mouth probing should be done.  A super important part of this conversation is which codes can be used and when.

Below is our office protocol for a standard new patient with no periodontal concerns.  Not including radiographs, we expect to see the regular prophy code (D1110) and comprehensive examination code (D0150) for their first visit.  Their subsequent recare appointments would use the same prophy code for the cleaning and a periodic evaluation (D0120) for the exams.  Pretty straightforward.

Hygiene Normal Visit

Hygiene Perio Visits

After the S/RP is all done, we should be bringing these patients back for a re-evaluation (D0170) 4-6 weeks later, just like we were taught in dental school.  We need to determine if our therapy has worked and contemplate a referral to a periodontist as needed.  At this visit, our hygienists will re-probe the areas of interest and inspect the patient’s home care.  This is also a great time to review and bill for OHI (D1330) although we’ve probably been working with the patient on this since the first visit.  It’s at this visit that we can also determine the appropriate recare cycle: 6, 4, or 3 months.

For future recall visits, we would use the D0120 periodic evaluation code as normal but we should not use the prophy code.  If you look at the CDT, prophys are done on patients who do not have periodontal disease.  A patient who has had S/RP should have a periodontal maintenance (D4910), which pays more to compensate our hygienist for the extra work they’ll have to do to keep this patient healthy.

So there it is.  Quite simple, really.  But I find that a lot of offices don’t correctly and consistently use hygiene codes.  Print up these charts and use them as “cheat sheets” for your hygienists.

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