January 19, 2023 • 3 min read

5 Steps to Understanding Medical Billing for Periodontics

Moving to a new home can be scary, especially when inspecting the foundation. Let's ask how your practice foundation is.



Laurie Owens

CPC | CPB | COC | Director Of Medical Billing Education for Devdent

Medical Billing for Periodontics

Buying a new home, uprooting your family, and leaving the familiarity of your old life behind is scary. Moving from state to state can bring some trepidation. During the initial inspection, there are questions that echo in your mind. How is the foundation? What is it made of? When was the last inspection done? Let us ask you, how is your practice foundation?

Introducing new regional concepts like landscaping and the fact that your grass will be brown during the winter months because it’s dormant is not unlike explaining to your patients what periodontics is. 

At our practice in Kenmore, Washington, we would help our patients understand by saying, your primary dentist provides care for your teeth, but when the structure is at risk, they send you to us.  That is all we do so your dentist can focus on the rest. All providers dispense periodontal care, but there are 5 steps to understand how medical billing for dentistry comes into play in periodontics.

1) Know what breaks down the oral structure:  

You need to have a full understanding of “what has caused this” because that is “what” you are treating.  For instance, “Due to the xerostomia caused by the Sjogren’s syndrome with dental involvement, Sue Smith requires the removal of #12 and 13, repair the moderate maxillary atrophy with membrane and bone stabilizing implants. Stabilizing the bone will provide sufficient mastication and asymmetry.”

The reason many providers are not successful with medical billing for dentistry is that they do not understand or relate the breakdown within their notes.  Chart notes are VITAL to medical billing success.

2) Document the facts:  

From their medical history, to medications, to oral complications these all must be included in your SOAP (subjective, objective, assessment, plan) notes.  When you put “reviewed HH” this will not cut it!  

Copy and paste straight out of your software into all your exams.  Here are some perio tips:

Generalized or localized?

Chronic or aggressive?

Minimal, moderate, or severe?

Without clear documentation, you are shooting your staff in the foot and cutting the medical billing off before it starts.

3) Detail the details:  

Remember, if you did not add it to the note, it did not occur.  

Medical records (or chart notes as you know them) will always complement the coding.  What that means is as the “experts” you need to make sure that all of the details are there for proper coding! It could mean a yes instead of a no from medical insurance. 

For example: 

Bone grafting is vital to sustaining the maxillary and mandible ridges.  Yet, when you denote that you are doing bone grafting, why are you not stating the severity of loss (atrophy)?  When you have this detail in your notes, you can increase your medical billing payment because of its severity. However, it is important to remember, DO NOT FABRICATE OR EMBELLISH this information. All notes must be truthful and thorough. 

4) Denote the Emergency or Urgency: 

Many patients in periodontics could be considered urgent or emergency treatment for medical billing.  

You may run into a problem with billing medical insurance if the necessity is not stated.

Is the infection substantial to the point that they could end up in the hospital?  Unfortunately, it isn’t possible to see into the future, which means that it is important to make sure that the patient and their medical records reflect that the infection could cause a dangerous effect. 

Since infections can consist of multiple strains of bacteria, and you may not always be able to pinpoint the strain, it is best to err on the side of caution. Stating that the scenario could lead the patient to the emergency room if treatment is not completed could help your case. 

5) Trauma happens: 

In dentistry, we see many emergencies on a monthly, and sometimes weekly basis.  Anytime the structure is damaged, it is periodontics.  Whether you need to stabilize the dentition or remove the fractured tooth, this is trauma.  

Are you gathering the details of when, where, and how the trauma occurred? 

Even if it is an old trauma that is now exhibiting new symptoms, the same information must be obtained to get sequela benefits.  

For instance: Your patient was 8 when he was sledding and hit a tree fracturing the lower anterior region.  30 years later, the crowns that were placed to correct the fracture have now failed and they have sheared to the gum line.  Is that dental or medical?  It would be a medical sequela for sure!

Creating a foundation using the 5 steps above will help your clinical records no matter if you are medical billing for dentistry or billing dental insurance. These apply in almost every specialty we have in dentistry, The real question is, are you doing them?  

Imagn Billing can help you provide better patient care and increase case acceptance for those perio patients! Get started today by visiting our website.

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