The Clash over Full-Mouth Debridements

Few dental procedures cause more controversy between front and back teams than full mouth debridements.  Not only is the procedure difficult to say, it’s also challenging to get insurance companies to pay for the treatment unless you follow certain steps.

Clinical teams typically recommend debridements to new patients who arrive with heavy amounts of calculus on their teeth.  When the calculus is too heavy to get accurate periodontal measurements—which prevents the dentist from completing a comprehensive exam—full mouth debridements come to the rescue.

The challenge is that debridements are considered preliminary procedures.  The dental CDT codes state that debridements enable a comprehensive exam, and many insurance companies interpret that to mean comprehensive exams and even x-rays should not be taken at the same time.  And that’s what creates the battle between the clinical team that values the procedure and the front team that has to deal with the insurance company.

So how can you utilize this great service and get reimbursement?

First, understand that insurance companies are likely to not pay for debridement claims when submitted with comprehensive exams.  Many practices work within this limitation by coding a limited exam when patients have too much calculus to complete a comprehensive exam.  The comprehensive exam is then done after the patient has the debridement and the gum tissue has time to heal.

The second thing to keep in mind is that some insurance companies downgrade debridements to a regular cleaning benefit.  This means the patient will have extra out-of-pocket costs.  However, when the team prepares the patient ahead of time for extra costs, most patients proceed with treatment.

Finally, make sure the clinical team prepares a narrative for the front team.  This is often needed for debridement claims.  Knowing this ahead of time will save the front team a lot of time.

Full mouth debridements are a beneficial yet tricky service to bill correctly.  By understanding a few key points, you will enjoy greater success in utilizing this procedure.

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