How Much Radiographic Bone Loss is Needed for Scaling and Root Planning?
The x-ray shown below is included on Delta's website as an example of a GOOD x-ray highlighting both calculus and bone loss.1
Let’s review in greater detail what x-rays reveal about bone loss. Remember, you and a claims examiner are looking for aspects such as:
- Loss of lamina dura: Seen at every site on this x-ray.
- Interproximal negative anatomy (valley instead of hill of bone): Seen everywhere except interproximal between 3-4.
- Signs of vertical bone loss: Especially harder to see spots like the mesial of #4 that is not completely through buccal-lingual width.
- Loss of Buccal/Lingual bone that is not even: Interproximal of 30/31 shows a good 2mm height difference between the two.
- Any horizontal bone loss 2mm or more away from the CEJ
- Radiographic calculus
To ensure that an insurance claims examiner sees exactly what you see, and agrees with your scaling and root planning treatment, every problem you notice should be documented in a narrative or circled/marked on the x-ray, especially harder to see items such as points #3 and #4 as they are often overlooked by busy reviewers who must process claims in a matter of seconds. TIP: If you send a marked x-ray attached to your claim, send an unmarked one as well to avoid them delaying the case asking for the original.
While it’s true that X-rays are the least important part of perio from a diagnosis view (must lose 60% of bone before the human eye can pick it up on an x-ray), they are still a critical component reviewed in insurance claims and should be utilized appropriately to achieve reimbursement for your patient.
Many offices are undertreating perio. Don't let the common fear of getting reimbursement be the crutch that prevents you from treating patients for their disease! The vast majority of denials for SRPs are simply due to poor documentation. With correct documentation, SRP claims should be easy to get covered.
If you want to see all the steps on how to get 99% of SRP claims paid, I recommend taking the Achieving Reimbursement for Periodontal Treatment course.
1“Why your claims with x-rays are being denied and what you can do: “ https://fyi-online.com/2022/04/x-ray-claim-tips/
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