Submitting for 3 or More Quadrants of Scaling and Root Planing
Periodontal Scaling and Root Planing – 4 or more teeth per quadrant (D4341) is a therapeutic procedure for patients with diagnosed periodontal disease. It's designed to remove cementum or dentin that is diseased or roughened by calculus, either as definitive treatment and/or pre-surgical care.
About the Procedure
More specifically, as described by the American Dental Association’s Current Dental Terminology (CDT), “This procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature. Root planing is the definitive procedure designated for the removal of cementum and dentin that is rough, and/or permeated by calculus or contaminated with toxins and microorganisms. Some soft tissue removal occurs. This procedure may be used for definitive treatment in some stages of periodontal disease and/or as a part of pre-surgical procedures in others.”1
The ADA also notes that scaling and root planing is expected to result in “overall net gain in clinical attachment,” though there is also the potential for “possible pain the day of or the day after treatment, possible increase in dental hypersensitivity within a week; rarer chance of fever or myalgia.”2
Thoroughly removing calculus and diseased tissue to allow appropriate healing requires sustained effort. Additionally, due to the potential for discomfort, scaling and root planing is almost always done using local anesthesia. As a result, traditionally, only one or two quadrants are done on a given date of service. Nevertheless, there are occasions where a dentist and the patient may choose to do scaling and root planing on three quadrants, or the full mouth, all on the same day.
Submitting Claims
In general, claim submissions for scaling and root planing need to demonstrate documentation of bone and clinical attachment loss; pockets should be greater than 4mm. This is especially the case when doing three or more quadrants on the same date of service. The ADA Council on Dental Benefit Programs notes that “When submitting scaling and root planing for more than two quadrants within a single visit, a best practice would be to send documentation, including full-mouth periodontal charting, FMX, periodontal diagnosis and the treatment plan.”3 This is consistent with Delta Dental's policy requiring that submission of more than two quadrants of scaling and root planing on the same date of service include required documentation.
While most dentists are already providing the needed documentation, including charting and radiographs, Delta Dental of Virginia will be enforcing this policy beginning December 1, 2021. Submissions for three or more quadrants of scaling and root planing without the required documentation is non-billable to the patient. Dentists can choose to resubmit with the needed information, or alternatively under a different code, such as D4346 or D1110.
To avoid an adverse outcome, it is important to be aware of the criteria before submitting a claim. If you wish to appeal the decision, be sure to provide additional detail in the form of radiographs, additional charting, and potentially a narrative. A narrative could include additional information such the rationale for doing the additional quadrants on the same date of service, as well as evidence of additional anesthesia used or time spent with the patient.
Michael D Weitzner, DMD, MS
Dental Director, Delta Dental of Virginia
1. Current Dental Terminology (CDT-2021), American Dental Association, 2021
2. Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts, Journal of the American Dental Association 146(7), 2015
