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Searching: healthy gum
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Message Board
Views: 257 | Replies: 4
. What to do? Any ideas as to the narrative that may get this covered for the patient? I'm assuming the tooth does have some perio but doesn't have a guarded prognosis. You need to send in probing numbers ,a picture of healthy gums with your prognosis, again assuming it's better than guarded
April 26, 2014
Claims Processing
Message Board
Views: 594 | Replies: 36
not like they are doing this to a healthy tooth. They are crowning it anyways. I always wondered if this is ok to do? Devil is in the details, meaning actually PM me the photos and x-rays you have. Reason: A vast majority have photos or x-rays missing key data, not showing the entire tooth, poor angle
April 02, 2026
Claims Processing
Message Board
Views: 294 | Replies: 7
is healthy. Dear Doctor: Defined: D4212 - gingivectomy or gingivoplasty is to allow access for the restorative procedure per tooth. It is also for providing margins for crown preparation. Most payers include any soft tissue procedure at the same time as the tooth restoration to be global or inclusive
August 19, 2023
Claims Processing
Message Board
Views: 307 | Replies: 22
Hello, has anybody had luck getting an insurance company to pay out on work recently done at another office? A NP came to my office with awful crowns on 2-4. They are emax, awful margins and cement everywhere. They were done 2023. We tried scaling to help remove some of the cement and improve gum
July 30, 2025
Claims Processing
Message Board
Views: 1149 | Replies: 57
definitely worse. Even with narrative spelling out the exact tooth numbers with bone loss amount and intra oral pictures of perio probe in the gums you will still get denials. They are using AI to "measure" radiographic bone loss. Apparently AI has no idea what an intra boney defect is. If the perio
September 16, 2025
Claims Processing
Message Board
Views: 394 | Replies: 8
a little gum for your impression but when I do a surgical crown lengthening I routinely get paid. Just got a Gemini laser a month ago. It's awesome, but getting insurance to cover anything because it's a laser doesn't happen. They pay based on the procedure, not the means. Laser, scapel, bur don't matter
August 18, 2021
Claims Processing
Message Board
Views: 266 | Replies: 4
weeks after completion of SCRP. Is it appropriate to charge code 4910 perio maintenance at this visit? Thanks, Brandon At treatment planning visit, I say that after we remove all the tarter and bacteria by doing deep cleaning, you'll have to come back every 3 months for maintenance visit. Gum
January 30, 2015
Claims Processing
Message Board
Views: 93 | Replies: 3
Hi, townier. One patient have a fractured crown for RCT treated tooth. We cannot do extraction for that tooth due to medical condition (fosamax taking). Then I trim down that tooth to gum level and sleep that tooth, place a RPD for patient. However, the insurance denied the claim and stated
March 07, 2021
Claims Processing
Message Board
Views: 575 | Replies: 28
Patient comes in for recall and we complete perio charting. All is healthy, except 4 5mm pockets around 14/15 area. Hygienist completes Prophylaxis that day, we schedule patient back for 1h for her to anesthetize and complete SRP 1-3 teeth D4342 around #14,15. We submit both claims on their dates
February 13, 2023
Claims Processing
Message Board
Views: 307 | Replies: 8
these high max plans have extremely low fees or other things that will make it nearly impossible to ever reach $20k, even with full mouth rehab.It's a little known fact in Michigan that most State employees have 100% coverage with no limit for perio surgery (and perio surgery only). I figured that some union negotiator's husband probably needed gum surgery 20 years ago and it got into a contract and has been there ever since.
December 02, 2014
Claims Processing
Message Board
Views: 984 | Replies: 22
surfaces, even subgingivally does not constitute PSRP, no matter how difficult or time-consuming the removal may be. • A prophylaxis is the appropriate code to report when removing calculus (supragingivally and/or subgingivally) from the teeth, even when the calculus extends below the gum line
February 05, 2016
Claims Processing
Message Board
Views: 408 | Replies: 11
such as: (A) Gum tissues which cannot bear the pressures placed upon them resulting in excess tenderness and sore spots, (B) Jaw ridges which may not provide adequate support and/or retention, (C) Musculature in the tongue, floor of the mouth, cheeks, etc., which may not adapt to and be able to accommodate
September 25, 2014
Claims Processing
Message Board
Views: 288 | Replies: 20
with the front 8 teeth and then waited 6 weeks for healing to start the denture process. This temp would be out of pocket. Or the patient could gum it for a few months...how to handle this? I always had the patient pay for the temp and then use their insurance for the permanent ones. Good Luck. Don't
March 30, 2022
Claims Processing
Message Board
Views: 301 | Replies: 8
in coding that has plagued dental insurance coders for years. “Current codes document treatment procedures for patients with a healthy periodontium or patients with periodontal disease that has accompanying loss of attachment — such as periodontal pockets and bone loss,” said Dr
March 21, 2016
Claims Processing
Message Board
Views: 237 | Replies: 6
, no allowable charges to the patient. So my choices are: 1) appeal and wait... 2) nothing, do a prophy and tell the patient when her gums are really bad and her insurance decides they'll cover it, then to have treatment done? 3) send her to a periodontist? 4) refuse to do below the standard of care
November 24, 2016
Claims Processing
Message Board
Views: 99 | Replies: 4
healthy account of funds to pay claims. Now, this is if the policy is a traditional insurance policy that is fully funded by the insurance company. Almost half the policies in the country are self-funded by the employer. These policies the insurance company is only the administrator of the funds
January 02, 2024
Claims Processing
Message Board
Views: 1161 | Replies: 34
or tract. I asked her if she ever had any problems with that tooth or if she ever noticed a pimple on her gums above that tooth. She said it will get a little pressure sensitive and a pimple will appear and she will just pop it. She also claimed that she would get frequent sinus infections
March 30, 2015
Claims Processing
Message Board
Views: 213 | Replies: 5
dentist told me to extract a tooth during the job interview. Just to show off my ext skill, I told her that I could extract it without grabbing a surgical bur. She still called it surgical extraction just because the tooth was broken at the gum line and probably because she can get paid more from
December 12, 2016
Claims Processing
Message Board
Views: 94 | Replies: 1
for adults in the state. (9/1) Share: Peter J. Polverini, former dean of the University of Michigan dental school, calls for an expansion of Michigan's Healthy Kids Dental to bring much-needed care to children. The program, a joint effort by Delta Dental
September 07, 2014
Claims Processing
Message Board
Views: 160 | Replies: 5
. I thought that once they were diagnosed as having gum disease, they are automatically shifted to 3 month recalls from 6 month recalls... The insurance system is a joke! and a huge GAME. They don't update when they should only when it's to cut back benefits. Know the basics and have a good
March 08, 2014
Claims Processing
Message Board
Views: 178 | Replies: 5
annually and if there is bleeding it could be an indication of refractory active perio and an indication to repeat quad therapy. This is what insurances are looking for. So every few years they expect you to repeat the therapy as studies show patients reactivate and the therapy needs to be repeated. This will crate the history for perio maintenance you are looking for. In addition, it will build your perio practice and keep your patients healthy.
January 01, 2022
Claims Processing
Message Board
Views: 349 | Replies: 6
. Agree with the send crown claim on seat date You could also do the endo and core one day And crown another day That's typically what I do Also helps keep the endo healthy instead of risking cavit coming out What does your narrative say when doing a cerec and buildup on the same day?
August 29, 2015
Claims Processing
Message Board
Views: 1310 | Replies: 26
gums are jacked up, cleaning them was hard, please send me money. Send full mouth probing if you didn't. That's usually required. One problem you can run into as well is some insurance plans have specific statements in the contract that say they only PAY for service if there is 2+mm bone loss on RG
April 10, 2017
Claims Processing
Message Board
Views: 715 | Replies: 18
and billable procedure to knock all this off and irrigate the hell out of him gums so when you comes back for SRP then it's not so nasty. When the ins. co. tells my patient that my clinical decision was not justified, it makes them question me. This isn't a matter of how to be creative with CDT codes, it's
July 19, 2016
Claims Processing
Message Board
Views: 114 | Replies: 1
. But what do we do if a patient refuses? Do we refuse to treat them and recommend they find another office? This is where my front office is up in arms....the idea of losing patients is creating panic in her. I told her we can not bill for an adult prophy as if they are healthy when
January 28, 2014
Claims Processing
Message Board
Views: 694 | Replies: 22
input is greatly appreciated. Don't let others get you down. You need to take good intraoral camera pictures of walked gums and build up and attach to the claim. Your OM needs to learn how to get paid for every single claim Photos, accurately made X-rays , and chart probing should be sent
June 30, 2025
Claims Processing
Message Board
Views: 369 | Replies: 18
has gum disease, explained his perio condition to him, explained SRP procedure, doing 1/2 mouth at a time with anesthesia; IOC photos taken to show pt; informed pt that there may be more cavities along gumline..that after we do the cleaning, we may find more cavities, pt aware; pt likes drinking
January 19, 2016
Claims Processing
Message Board
Views: 273 | Replies: 5
teeth, but pocket depths are in the healthy range. I realize that this is only my opinion, and a completely subjective observation. Additionally, bone loss may be a historical feature of past periodontal disease, and not not active disease. So in these situations where there is only mild periodontal
June 04, 2014
Claims Processing
Message Board
Views: 552 | Replies: 13
talking from a phobic pt standpoint. Not productive from a money standpoint. I'd rather see the gum removed, buildup, endo and core in one appointment rather than initiate a treatment then refer but that could be debated. I'd still recommend removing this tooth.
February 22, 2014
Claims Processing
Message Board
Views: 220 | Replies: 8
eligibility.Does it integrate with old version of dentix ? Version 11I believe so it integrates with most softwares. here is the website: ExtraDent realizes checking patient eligibility is the first step to having a healthy revenue cycle. Insurance eligibility confirms the patient's plan information
October 18, 2019
Claims Processing
Message Board
Views: 352 | Replies: 11
-to-peer review with your diagnosing dentist to discuss the necessity of these restorations further. I appreciate your prompt attention to this matter, as it directly impacts our patients ability to maintain a functional and healthy dentition. I believe a lot of insurance companies immediately deny
March 19, 2025
Claims Processing
Message Board
Views: 1027 | Replies: 36
you reject it, you might want to read a bit about it. Coding isn't just about dental benefits; coding is about metrics. We are fast moving into a world where payment is based on how healthy we help become, not just the level of disease. We need to have ways to count what we are acutally treating
November 28, 2016
Claims Processing
Message Board
Views: 325 | Replies: 11
to 45 minutes for a prophylaxis which is on a healthy patient...explain how someone accomplishes 4 quads of scaling (or even 2 or 3) in an hour. 2 is possible...but this is the augument, how effective was that treatment in the time alotted for that treatment when it is only 15 minutes greater than
February 24, 2025
Claims Processing
Message Board
Views: 365 | Replies: 6
legitimate buildups. Probably some truth here Most of my crowns get a buildup. I was told by the main director of one of the largest insurance carriers this same line. I explained clearly to him that I place a buildu up because I do not crown healthy teeth or virgin teeth...all my crowns are done
February 22, 2014
Claims Processing
Message Board
Views: 183 | Replies: 11
of questions in depth from insurance companies stand point. Just curious !!! I've gotten into the habit of just doing it anyway. If it's a perio disease case, then I send to the periodontist and let them handle it. If it's CL in a healthy mouth, then it just takes a few minutes to chart the quadrant
March 01, 2014
Claims Processing
Message Board
Views: 1134 | Replies: 19
was not indicated and it would have provided zero benefit in this specific situation. It would have only made her gums more sore and her tongue would have been annoyed with the knots. I would not refund a penny.I've never heard of an insurance company denying coverage for a surgical extraction
March 21, 2019
Claims Processing
Message Board
Views: 554 | Replies: 13
the gums swelled UP. If this is the case, then it should resolve with routine scaling, and root planing is not necessary (this is what THEY say, not necessarily what I feel) Therefore, Insurance companies are demanding evidence of bone loss. Normal biologic width averages about 2mm. So theoretically
September 08, 2014
Claims Processing
Message Board
Views: 3400 | Replies: 160
periodontal (gum) disease has been treated and stabilized before other benefits will be considered. The patient had 2mm recession with 3mm max pockets and no BOP. Granted there is some attachment loss and I do understand that #s 2 & 3 require perio. tx. but to deny #s 4 & 5 is ridiculous
June 25, 2014
Claims Processing
Message Board
Views: 315 | Replies: 5
of crown preparation 2 if you do crown lengthening it is done on healthy periodontium and the crown cannot be placed sooner than 6 weeks later. 3 when the ins company does not pay for a proceedure it is stated as either denied or disallowed. 4 if it is denied then you can charge the patient
March 14, 2014
Claims Processing
Message Board
Views: 963 | Replies: 29
book.If the tooth broke before we saw the patient I give that info as well, such as the ML cusp broke off at the gum line and work this into the above statement. Build-ups have a specific guideline I believe that it is over 1/3 of the tth structure must be lost to decay and or breakage. The more detail
March 26, 2018
Claims Processing
Message Board
Views: 368 | Replies: 14
or be greedy.Interesting to hear about the deductible - that makes a lot of sense. My average wisdom tooth case is a healthy teenager which would be very unlikely to have met their healthcare deductible.Eddie I just did the math, and for most of my patients who have Delta, I get $275 each impacted wisdom
December 24, 2021
Claims Processing
Message Board
Views: 1871 | Replies: 57
ones hit because they are easy targets.This may be a dumb question but when measuring GM you are referring to measuring recession right? A lot of people refer to it as recession, yes. GM is what most softwares label it, and it is more accurate because healthy tissue starts at around -2 GM, meaning
August 27, 2019
Claims Processing
Message Board
Views: 3400 | Replies: 160
understand that it is in the evil insurance company's best interest to keep the patient as healthy as possible, as this increases the evil insurance company's bottom line. The evil insurance company's bread and butter comes from healthy patients that require fewer dental procedures. My patient
June 21, 2014
Claims Processing
Message Board
Views: 1258 | Replies: 62
that it will not be covered until a cusp fractures. They have better things to do with their clients' premiums then help them stay healthy Not so fast. This is all that has been submitted for review here. In my opinion as a former consultant this tells me nothing. What do you see in this photo. I see a molar
December 23, 2023
Claims Processing
Message Board
Views: 1493 | Replies: 20
manager says. You bill for what you did and the patient pays for what they have received. Oh wait, delta doesn't allow that? Time to drop delta then. Frankly, your office manager is wrong. We do that all the time. Swollen gums? Sensitivity? looks like we have bone loss going on. Ms. Smith here
June 15, 2018
Claims Processing
Message Board
Views: 9518 | Replies: 565
for sealants but would pay for fills? Now I totally realize you have to somewhat take what patients say with a grain of salt but save for these 3 fills this guys mouth was totally healthy and he told me this with a straight face? Crazy if true and I can't imagine why he'd make something like that up
May 28, 2011
Claims Processing
Message Board
Views: 1017 | Replies: 45
at getting patients to direct their anger at the doctor, instead of where it belongs. I would rather make sure my patients understand I am solidly focused on helping them get healthy and stay healthy. We are having the patient file complaint's with our state insurance commissioner and the state where
May 24, 2019
Claims Processing
Message Board
Views: 442 | Replies: 25
to an employee that incents them to be healthy. In those cases, those benefits go to the patient. So if a small balance remained from primary, a claim is sent to AFLAC, they send $25 to the office (remaining balance was $9) then $16 goes back TO THE PATIENT. this Yes. John and most others who posted
December 14, 2017
Claims Processing
Message Board
Views: 749 | Replies: 31
screwed.Rads have to show bone loss.They dont give a crap about how much calculus there is or gum inflammation.I have definitely noticed more SRP issues over the years. United Concordia is the worst offender.Just stick to the dental insurance guidelines on what they want to see is a SRP patient.You can
December 11, 2020
Claims Processing
Message Board
Views: 4364 | Replies: 284
I stand corrected, uncollected funds in a healthy practice is 2%. I guess that disqualifies me from being of service to some. Does overhead go on patient continue on, patient or no patient? How much does that cost? If staff is 30% of your overhead ( with benefits it is ) and there is no patient
February 20, 2016
Claims Processing
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