initiated included scaling and root planing and oral hygiene instruction. Periodontal Scaling and Root Planing Policy United Concordia’s policy for claims submission of periodontal scaling and root planing (PSRP) (D4341, D4342) requires submission of diagnostic materials from all general dentists and non‐ periodontal specialists, regardless of the patient’s age. 4. Section 5 of the ADA Principles of Ethics and Code of Professional Conduct is particularly applicable when determining the treatment plan and procedure coding. Insurance companies look to make sure your patient meets a certain criteria when the company considers a claim for scaling and root planing. Read this interesting discussion of a periodontal case denied. SECTION 5 — Principle: Veracity ("truthfulness") The dentist has a duty to communicate truthfully. Jun 10th, 2019. I am writing to appeal the denial of my claim number 789 for my root scaling procedure that was performed on September 3, 2013. Based on the patient's clinical presentation, I placed PerioChip® in each of the pockets listed below: Tooth # Site Treated (MB B DB ML L DL) Probed Pocket Depth Total Treated Areas by Tooth Insurance narrative for scaling and root planing. Download. Letters: Scaling and root planing April 16, 2018. prophylaxis, scaling and root planing, or debridement procedures. If resubmitting a claim on appeal, send additional documentation of some kind. This addition to DIQ's downloadable dental forms will help your practice collect what's owed to you for scaling and root planing. MetLife Denied Root Planing Claims are denied for many reasons. Office Forms. Scaling And Root Planing Narrative Periodontal scaling and root planing, per quadrant involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces. Always appeal with an explanation outlining the circumstances and the time involved, D1110 may be reimbursed. First of all, Karen Jones, who works for my dentist, Dr. Sherry Grant, contacted the insurance company and received a pre-authorization for the procedure. On behalf of the over 7,500 members of the American Academy of Periodontology, I would like to respond to the article, "ADA Resources Can Help Dentists With Scaling, Root Planing Claims Process" (ADA News, Feb. 5).The author cites that periodontal scaling and root planing tends to have the highest frequency of dental insurance claims denial. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic in nature. Latest in Office Forms. I did write a narrative explaining the condition, but the consultant denied it ... [scaling and root planing, putting the burden of proof on the doctor. Nov 12th, 2020. The denial states that the procedure was not medically necessary. Office Forms. When a patient requires scaling and root planing on two teeth in the same quadrant and prophylaxis on the remaining quadrants, if both D4342 and D1110 are provided on the same day, reimbursement for the prophylaxis is usually denied. If narrative does not fit on the claim form, write it on a separate page, and note this on the claim in the narrative section. I will discuss D4341—scaling and root planing four or more teeth, per quad, and D4342—scaling and root planing one to three teeth, per quad. Informed consent crown and bridge. Claim Rebuttal Narrative Dear Dr. (Medical Director's name), ... PerioChip® is indicated as an adjunct to scaling and root planing procedures for reduction of ... (List additional information attached to appeal including patient history, diagnosis, past treatments, and product information such as package insert). It is appeal narrative for scaling and root planing for patients with periodontal disease and is therapeutic, prophylactic... 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