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Delta Dental of Virginia continues to receive questions regarding the submission requirements for Scaling and Root Planing (SRP). This message serves as a reminder of important information shared in earlier communications to help ensure better payment outcomes for SRP submissions.
D4341: Periodontal Scaling and Root Planing – Four or More Teeth per Quadrant
This therapeutic procedure is for patients with diagnosed periodontal disease. It is designed to remove cementum or dentin that is diseased or roughened by calculus, either as definitive treatment and/or pre-surgical care. As with any other periodontal treatment, the goal of SRP is to alter or eliminate the source of periodontal disease-causing bacteria and to reduce inflammation and other risk factors for periodontitis.
Submission Requirements for Payment
To qualify for payment, claim submissions must include documentation of bone and clinical attachment loss, and pockets should be greater than 4 mm. If fewer than four teeth in a quadrant meet the criteria, the procedure may receive an alternate benefit of D4342: Periodontal Scaling and Root Planing – One to Three Teeth per Quadrant.
SRP should not be billed at the same time as other non-surgical services and would be considered integral to periodontal surgery if billed on the same date of service.
Alternate Benefits
If there is no evidence of bone loss or attachment loss, the submission may receive an alternate benefit of D4346: Scaling in the Presence of Generalized Moderate or Severe Gingival Inflammation-Full Mouth, After Oral Evaluation. This procedure is designed to manage moderate to severe gingival inflammation in the absence of diagnosed periodontitis and should not be reported in conjunction with prophylaxis, SRP, or debridement procedures. If the submission does not meet the criteria for SRP or D4346, an alternate benefit of D1110: Prophylaxis – Adult may apply instead.
Documentation Requirements
The submission should be supported by the following documentation:
- A full mouth series of radiographs, or periapical and bitewing radiographs of good diagnostic quality, clearly showing bone levels for all teeth in the quadrant(s) being treated.
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Periodontal charting that is 12 months old or less, including details on probing depths and clinical attachment loss.
In addition to diagnostic-quality radiographs and current periodontal charting, offices are encouraged to provide any supplementary information that could help ensure claims payment. This might include photos of gingival inflammation and/or a narrative that outlines contributing factors (such as diabetes or a history of smoking).
Appeals Process
If a submission was denied or received an alternate benefit and you wish to appeal, please include additional documentation to support your appeal. This could include additional radiographs, photos, chart notes, and/or a narrative that provides additional information not included with the original claim.
Appeals must be received within 180 days of the denial and sent in writing via:
Michael D. Weitzner, DMD, MS
Dental Director
Delta Dental of Virginia
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