Training Tip Difficult Propyhylaxis:
Full mouth debridement (D4355) is justified when the comprehensive oral exam CANNOT be completed (D0150) or the comprehensive perio evaluation CANNOT be performed due to excessive ad bulky calculus, heavy, plaque, and debris buildup. D4355 is only a prep treatment and it's used to prepare the dentition for a subsequent oral evaluation.
The purpose of coding a a difficult prophy is to be able to do a comprehensive exam after but not on the same date that should be the next appointment. D4355 is only a paid benefit in contracts 25-33% of contracts when sequenced perfectly. It's a good idea to check benefits to see if your patient has coverage for this. You have to carefully schedule treatment correctly after the difficult prophy is done, an exam at a subsequent appointment should be scheduled at that time generally 14 days later to allow for healing. A comprehensive exam should be done then a decision is made to do a prophy or schedule for a scaling a root planing. A narrative is needed when coding a D4355 and should describe the heavy calculus and plaque preventing an evaluation, x-rays should be included.
Note a difficult prophy code should not be used for a difficult patient.
Full mouth debridement (D4355) is justified when the comprehensive oral exam CANNOT be completed (D0150) or the comprehensive perio evaluation CANNOT be performed due to excessive ad bulky calculus, heavy, plaque, and debris buildup. D4355 is only a prep treatment and it's used to prepare the dentition for a subsequent oral evaluation.
The purpose of coding a a difficult prophy is to be able to do a comprehensive exam after but not on the same date that should be the next appointment. D4355 is only a paid benefit in contracts 25-33% of contracts when sequenced perfectly. It's a good idea to check benefits to see if your patient has coverage for this. You have to carefully schedule treatment correctly after the difficult prophy is done, an exam at a subsequent appointment should be scheduled at that time generally 14 days later to allow for healing. A comprehensive exam should be done then a decision is made to do a prophy or schedule for a scaling a root planing. A narrative is needed when coding a D4355 and should describe the heavy calculus and plaque preventing an evaluation, x-rays should be included.
Note a difficult prophy code should not be used for a difficult patient.
