In the CDT Coding Companion it states:
Clinical Coding Scenario #10: Periodontal Maintenance Therapy and Prophylaxis Visits Following either surgical or non-surgical periodontal therapy, the patient is placed by the treating dentist on a program of scheduled periodic periodontal maintenance (D4910) visits, which could be at various intervals (e.g., 2, 3, 4, or 6 months) depending on the patient’s clinical condition. The D4910 periodontal maintenance procedure includes removal of bacterial plaque and calculus (mineralized deposits) from subgingival and supragingival tooth surfaces, site- specific scaling and root planing, and coronal tooth polishing. Between these scheduled periodontal maintenance visits, the patient is also seen by the dentist for routine dental prophylaxis (tooth cleaning procedures). May the dentist code and bill for the prophylaxis procedure (D1110 or D1120) or is this prohibited as a duplication of existing services under D4910? Nothing in the D4910 or the D1110 (or D1120) code nomenclatures or descriptors make these procedures mutually exclusive. If the dentist determines that the patient’s periodontal health can be augmented with periodic routine prophylaxis procedures (removal of plaque, calculus, and stains from the tooth structures for the purpose of controlling local irritational factors), then this service should be performed and reported as D1110 or D1120, depending on the state of the dentition. Does it make any difference if the reporting dentist for prophylaxis (D1110 or D1120) is the same dentist providing periodontal maintenance (D4910)? No. The dentist should code and report for the services provided regardless of the provision of other services by the same or a different dentist. Will both procedures be reimbursed by the patient’s dental benefit carrier? Reimbursement will depend upon the dental benefit plan language and the contractual policies governing covered benefits.
*SRP is to clear the gums of anything that has been stuck up and allow the gums to heal to a healthy pocket size. If the patient has been doing what was necessary to take care of there gums and the dentist say their gum health has improved and as long as there is no bone loss then yes they can go back to a prophy. The insurance will want to see proof of the gum health (most likely). Yes there will be cases that will not be able to go back to a prophy because the gums will not be able to heal or they have entirely too much bone loss. Its best to see what the insurance company says about it plus you can always submit a preauth to see what they say about switching back over to normal maintenance.
