What is Scaling and Planing?
Scaling is the process of removing plaque and tarter from below the gumline. Planing (Root Planing or Curettage) is when the patient’s tooth root is smoothed out which helps the gums to reattach to the tooth. [1] Patients exhibiting periodontitis may undergo root planing and scaling as a treatment option.
How is it performed?
Patients are awake during the procedure, however, to reduce any pain or discomfort the dentist or dental hygienist will numb the mouth with a local anesthetic. According to the Cleveland Clinic[2], the provider uses a vibrating tool called an ultrasonic scaler to perform the scaling process. These steps may take place during tooth scaling:
- A vibrating metal tip on the scaler chips tartar off of your teeth above your gum line.
- A water spray on the scaler washes away the tartar and flushes plaque from the gum pockets.
- Your provider uses a manual (not powered) dental scaler and scraping device (called a curette) to remove small remaining pieces of tartar.
How is it billed?
- D4341 is the Current Dental Terminology (CDT) code for periodontal scaling and root planning; Four or more teeth per quadrant
- D4342 is the CDT code for periodontal scaling and root planning; One to three teeth per quadrant
What to look for?
Each payer may have a different policy, but it is recommended you look for:
- Multiple quadrants with planing and scaling on the same day
- Multiple visits in a given week, month, year[3]
Ways to detect suspect billing?
- Artificial Intelligence (AI) models identifying anomalous dental billing patterns.
- Alerts include, but are not limited to:
- Billing for medically unnecessary scaling and curettage (look for excessive units in a given time period);
- Excessive units for certain ages
- Unbundling along with other services
Healthcare Fraud Shield clients can review alerts 4000-01, 4014-01, 4067-20, 4067-30, 4071-01, 4074-20, 4074-30, 4075-20, 4075-30, 4076-01.
If you have questions or comments you may email us at [email protected].
REFERENCES
[1] https://www.mouthhealthy.org/all-topics-a-z/scaling-and-root-planing
[2] https://my.clevelandclinic.org/health/treatments/23983-tooth-scaling-and-root-planing
[3] Some plans have limitations with more than in a 24 month period. https://www.deltadentalin.com/getmedia/a24627db-9ebb-4bcd-b076-d13f0b98730e/FLI-6396-Provider-Prophylaxis-and-Root-Planing-Code-and-Billing-Guidelines.aspx