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UnitedConcordiaspolicyforclaimssubmissionofperiodontalscalingandrootplaning(PSRP)
(D4341,D4342)requiressubmissionofdiagnosticmaterialsfromallgeneraldentistsandnon
periodontalspecialists,regardlessofthepatientsage.
Therequireddiagnosticmaterialsinclude:
Fullmouthduplicateradiographsordigitalimages
Fullmouthcharting,including6pointspertooth
ForPSRPtobeconsideredforabenefit,thediagnosticmaterialsmustdemonstratethe
following,consistentwithprofessionalstandards:
Clinicallossofperiodontalattachmentand/or
Radiographicevidenceofcrestalbonelossorchangesincrestallaminaduraand/or
Radiographicevidenceofrootsurfacecalculus
Ifthesecriteriaarenotevidentuponprofessionalreview,theclaimforPSRPcannotbe
approved.
Bonelossmustbeevidentontheradiographstojustifythepresenceofcalculusandbacterial
depositsonrootsurfaces.Scalingofcalculusandbacterialdepositsfromenamelsurfaces,
whethersupragingivalorsubgingivaldoesnotconstituterootplaning.
TheADACurrentDentalTerminologydescribesperiodontalscalingandrootplaningas:
Thisprocedureinvolvesinstrumentationofthecrownandrootsurfacesofthe
teethtoremoveplaqueandcalculusfromthesesurfaces.Itisindicatedfor
patientswithperiodontaldiseaseandistherapeutic,notprophylactic,innature.
Rootplaningisthedefinitiveproceduredesignedfortheremovalofcementum
anddentinthatisrough,and/orpermeatedbycalculusorcontaminatedwith
toxinsormicroorganisms.Somesofttissueremovaloccurs.Thisproceduremay
beusedasadefinitivetreatmentinsomestagesofperiodontaldiseaseand/oras
apartofpresurgicalproceduresinothers.
TheJournalofPeriodontology,May2000(Supplement),p.853,furtherstates,inpart,thatthe
conditionsnecessaryforrootplaningmustbecharacterizedbyalossofclinicalattachment
duetodestructionoftheperiodontalligamentandlossoftheadjacentbonesupport.
Additionally,theremustbeinflammationofthegingivaextendingintotheadjacent
attachmentapparatus
Giventhesedescriptions:
PSRPisperiodontaltreatmentthatinvolvesinstrumentationofrootsurfacesand
removalofdeposits,toxinsandmicroorganismsfromrootsurfaces.
Ifbonelossisnotevidentand/ordepositsinvolveenamelsurfacesonly,whether
supragingivalorsubgingival,PSRPisnottheappropriateproceduretoreport,sinceroot
surfacescouldnothavebeenplaned.
Whenthedeposits,toxinsandmicroorganismsareremovedfromenamelsurfaces
only,thedentistmaywanttoconsiderwhethertheservicerenderedmoreclosely
relatestothedefinitionofeitheraprophylaxis(D1110)orafullmouthdebridement
(D4355).
Incaseswhereacomprehensiveoralevaluationcannotbecompletedwithoutpreliminary
debridement,D4355canbereported,whichisdescribedasgrossremovalofplaqueand
calculusthatinterferewiththeabilityofthedentisttoperformacomprehensiveevaluation.
Itshouldbenotedthat:
PocketdepthsarenotthesoleindicatorsforPSRP,sincepocketscanexistinthe
absenceofbonelossduetoinflammationofthegingivaltissues(i.e.,pseudopockets).
Apatientwithpocketdepthsof4,5oreven6mmcanhavecalculusonenamelsurfaces
only,withnoboneloss.Removingthiscalculusfromenamelsurfaces,even
subgingivallydoesnotconstitutePSRP,nomatterhowdifficultortimeconsumingthe
removalmaybe.
Aprophylaxisistheappropriatecodetoreportwhenremovingcalculus(supragingivally
and/orsubgingivally)fromtheteeth,evenwhenthecalculusextendsbelowthegum
lineandthereisnoboneloss.
Itisvitallyimportantthatpatientsbeencouragedtotakeanactiveroleinthemaintenanceof
theiroralhealthandthepreventionofdentaldisease.Apatientwhoisnoncompliantwith
homecareinstructionsmayrequiremorethanthecontractedlimitofprophylaxisallowedper
year.Patientswhorequireadditionalprophylaxisareresponsibleforthefeesassociatedwith
allservicesthatexceedthelimitsofthedentalbenefitprogram.
Pleasereadonforexamplesofacasethatwouldbeapproved,aswellasacasethatwouldbe
denied.
Theradiographclearlydemonstratesboneloss.Typicallythebonelevelisatorclosetothe
partofthetoothwherethecrownandrootmeet.Thereisalsoradiographicevidenceof
calculus(smallnodulesevidentonrootsurfacesbetweentheteeth)inallareasofthe
mouth.Thispatienthasperiodontitis,whichisadiseasethatresultsinbonelossleavingroot
surfacesofteethexposedtotheoralenvironment.Thisallowssaliva,foodparticles,and
bacteriatoattachtorootsurfaces.Whenthatoccurs,itisnecessarytoremovetheseirritants
fromtherootsurfaces,thusthetermrootplaning.Scalinginthiscaseisprovidedonthe
crownsurfacesofteeth.
Theradiographdemonstratesnoclearboneloss.Thebonelevelisatorveryclosetothe
junctionofthecrownandroot.Thereisevidenceofcalculus(thosesmallnodulesnoted
betweentheteeth)butthosenodulesareonthecrownofthetooth,nottheroot.Theroot
surfacesoftheteethareNOTexposedtotheoralenvironmentandaresafefromsaliva,food
particles,andbacteria.Asaresult,therootscannotbeplaned.However,thecrownsofthe
teethAREexposedandsubjecttocollectingtheseirritantscommonlycalledbypatientsas
tartar(thescientifictermiscalculus).Calculusoncrownsurfacesdoesirritatethegum
(gingival)tissuecausingthetissuetoswell,turnred,andbleed.Thiscalculusmustberemoved
fromcrownsurfacesbyscalingandispartofaroutineprophy,evenwhenremovingcalculus
frombelowthegumlinesincepartofthecrownofthetoothisbelowthegumline.