A patient was scheduled for D4341, but the hygienist decided that the patient did not have enough deposits to be considered a true quads patient. It ended up taking two appointments to do the cleaning and perio charting and the hygienist still wants to bill out as a D1110. I have never seen a prophy take two appointments to complete before. My question to you is should this remain a D1110 or should it be billed out as D4341 twice for left & right Quads? If no for both, what should it be billed out as? Thank you!

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Admin · Answer

In some cases a prophy may take two appointments if it is considered a "difficult prophy". If your hygienist does not feel the patient meets requirements for a RPS and only meets the criteria of a prophy then a prophy should be billed. However, you should note on the claim form in the remarks area that this was a "difficult prophy" that required two visits for completion and request additional funds for the time spent.

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