Sample appeal letter for scaling and root planing Sep 16, 2024 · A scaling and root planing consent form is a document used by dental practitioners to inform patients about and secure consent for a scaling and root planing (SRP) procedure. . After xrays and exam at my dentist they determined I needed a scaling and root planing on 4 teeth. Jan 28, 2025 · Claims for periodontal scaling and root planing (D4341 and D4342) are denied more frequently than those for many other procedures, according to the American Dental Association. Our three comprehensive templates are tailored to address various denial scenarios effectively. Mar 10, 2023 · Read more coding articles: New year, new ADA CDT codes Coding for scaling and root planing Question: How do you appeal a claim denial for D4341/D4342 (SRP) when the reason stated is “inadequate bone loss”? The patient exhibited 6 mm pockets in all quadrants with bone loss. Lack of Personalization Each appeal letter should be tailored to the specific case and include details about the medical services provided, the rationale for those services, and why the claim should be reconsidered. Tailor each letter to fit your specific situation, and keep copies of everything you send for your records. Building a dental claim narrative that works for scaling and root planing could contain the condition that the patient presented at the time of clinical examination. A winning scaling and root planing appeal letter can boost your collections, save patient relationships, and—if you play your cards right—lead to more loyal patients who spend 2x-4x more than the average insurance-only patient. . Sep 19, 2022 · Periodontal scaling and root planing (SRP) procedures (D4341 and D4342) tend to have a higher frequency for denial and/or requests for additional information from dental plans in comparison to many other procedures. Oct 8, 2024 · Here are three unique and detailed templates for a letter of appeal for reconsideration. Try Now! Fill Dental Appeal Letter Sample, Edit online. How do we go about this? May 28, 2025 · I am writing to appeal the denial of coverage for periodontal scaling and root planing performed on [Date]. Guardian denied the request for full quadrant scaling and root planing in all four quadrants but approved an alternate treatment benefit for scaling and root planing for one to three teeth (procedure code D4342) in the upper left and lower left quadrants due to bone loss in these areas. Background on this claim includes the first denial as “not a covered benefit under this plan”, the second appeal denied for “consultant review deems tooth has endo and perio involvement” resulting in the third I am writing to appeal a denial for 4 quadrants of scaling/root planing on (patient). The document is a narrative report on a patient diagnosed with active chronic periodontal disease, detailing risk factors, clinical findings, and recommended treatment protocols. In this guide, I’ll share my unique experience and offer practical tips, real-life examples, and three unique templates to help you write an effective appeal letter. Oct 28, 2020 · Narrative: Scaling and Root Planing necessary to remove subgingival microbiota both alive microorganisms and dead to prevent further bone loss. May 3, 2024 · 5. Oct 15, 2024 · Find out what you need to know about periodontal scaling and root planing, and discover the risks and benefits. Radiographs showed loss of crestal bone. Scaling and root planing was necessary to remove subgingival bacteria and prevent further bone loss. According to your letter dated [Denial Date], this treatment was denied as a non-covered service. Jul 30, 2025 · Dental Scaling and Root Planing can help stop gum disease early. We have several sample informed consent forms available for insureds. This form must be read and signed by patients to verify that they understand the procedure and agree to receive SRP treatment for gum disease (periodontitis). Sign, fax and printable from PC, iPad, tablet or mobile with pdfFiller Instantly. 18. The Appellant testified that she had appealed, and that ultimately that procedure (periodontal scaling and root planing) was approved. It emphasizes the necessity of non-surgical scaling and root planing as the first line of treatment to prevent further periodontal damage, along with potential adjunctive therapies and personalized home care instructions. These denials are the cause of much frustration among dental billers. (Testimony). Below are three unique templates for writing a dental insurance appeal letter. They told me I was covered and I checked my insurance which online shows that procedure is covered. Based on the patient's clinical presentation, I placed PerioChip® in each of the pockets listed below: Tooth # Site Treated (MB B DB ML L DL) Sep 29, 2024 · A well-written appeal letter should clearly explain why the claim should be reconsidered, citing specific details from your policy and providing supporting evidence. Sep 19, 2022 · It is always appropriate to appeal the benefit decision if the dentist thinks the claim has not been properly adjudicated. Discover how they work, their benefits, and when to seek periodontal care. (Now, that would make for some unique office decor!) Although instruments and techniques have been modified, scaling and root planing (SRP) remains the quintessential step in managing periodontal disease. Mar 26, 2025 · Scaling and root planing is a common treatment for periodontal disease that removes plaque and calculus (tartar) above and below the gumline. It involves removing plaque Nov 10, 2025 · Clear, professional templates to request a refund from your dentist after poor treatment, billing errors, or unmet expectations. Appellant has not carried the burden of showing the invalidity of MassHealth’s denial of the prior authorization for Dental Service Code D4341-periodontal scaling and root planing. But SRP codes are not the only CDT codes considered notoriously challenging to receive dental insurance benefit reimbursement for. After scale and root planing treatment, it is important to improve your oral care routine at home and to increase the frequency with which you see your dentist. According to The American Dental Association on periodontitis, we have identified and treated [the Petitioner] using their standard of care for periodontally involved patient. In this article, I’ll share my unique insights and proven strategies for writing no-authorization appeal letters, backed by industry expertise and real-life success stories. I understand that the procedure is considered to be cosmetic and therefore not covered under my insurance plan. Checking for errors in claim coding or misinterpretation of coverage terms may also provide grounds for appeal. D4341 & D4342 Benefits for D4341 and D4342 require root surface calculus, radiographic bone loss and bleeding upon probing. 9 Letter of Appeal For Scaling Root Planing jobs available on Indeed. Oct 1, 2024 · Discover the differences between scaling & root planing vs. California's Medi-Cal program once again covers dental services. undergo periodontal treatment may lead to, but is not limited to: Perio Narrative Sample Note: patient exhibits continued pocketing (5mm or greater) in this area, even after past scaling & root planing. Get Your Scaling and Root Planing Covered: Appeal Letter Tips Dear Mr. This deep cleaning procedure is designed to remove plaque, tartar, and bacteria from below the gum line and smooth the roots of the teeth, promoting healing and helping to prevent further progression of gum […] 스케일링과 루트 플레이닝을 위한 설득력 있는 호소문. Upon examination, periodontal pockets sites were found of 5 mm or greater and had localized bleeding when probed. Understanding Scaling and Root Planing Scaling and root planing is a deep cleaning procedure often recommended for patients with gum disease. Dec 13, 2024 · Scaling and root planing, often called deep cleaning, is an essential periodontal treatment that goes beyond routine dental cleaning. Apr 11, 2023 · Learn how to write a compelling appeal letter to your dental insurance company with our sample letter. Required documentation to support the delivery of scaling and root planing must consist of the following: Periodontal charting that records pocket depths, including 6 points per tooth, and indications of bleeding on probing. Tooth Scaling and Root Planing. Feb 16, 2023 · To help dentists improve their scaling and root planing claims, the ADA developed and published a new online resource. Feb 8, 2024 · Crafting a health insurance appeal letter requires a methodical strategy to articulate and justify your case, including challenging denials for services, treatments, or claims deemed experimental. ” The procedure Upon examination, periodontal pockets sites were found of 5mm or greater. Do SRPs need pre-authorizations and referrals Oct 7, 2022 · What's the right phrase 'scaling and root planing' or 'scaling and root planning'? The right expression is 'scaling and root planing'. Mr. Fill Dental Appeal Letter Sample, Edit online. There is heavy, radiographically evident calculus accretion in all quadrants. Tips to Make Narratives Faster and Easier Use templates—but customize them. Add immediate post-procedure observations, such as tissue response, and outline at-home care instructions provided to the Choosing CDT codes for scaling and root planing (SRP) can be challenging. If you have been diagnosed with periodontal disease, it means your gums have begun to pull away from your teeth’s roots, and tartar and plaque have become stuck on the root surfaces. These 17 detailed dental appeal letter samples will help you confidently request coverage for essential periodontal treatment. This area was scaled & root planed again and a “perio chip”- chemotherapeutic agent was placed in an effort to reduce the sub gingival flora. The MassHealth agency pays only for The Appellant testified that periodontal scaling and root planing had been requested prior to the instant appeal and had been denied. Jun 10, 2019 · This addition to DIQ's downloadable dental forms will help your practice collect what's owed to you for scaling and root planing. Mar 24, 2025 · The key to scaling and root planing is the instrumentation and removal of deposits from the root surfaces of the tooth. Nov 29, 2023 · Scaling and root planing, also known as deep cleaning, is a common dental procedure used to treat and prevent gum disease. Periodontal scaling and root planing is the removal of calculus, bacterial plaque, bacterial toxins, diseased cementum (the outer covering of the root surface), and diseased tissue from the inner lining of the crevice surrounding the teeth. g. com. Jul 12, 2025 · Today, I want to share my insights on how to write a scaling and root planing appeal letter. We cover what to expect before, during, and after the procedure, as well as the benefits of this treatment. Feb 21, 2025 · D4346 Dental Code Description The D4346 dental code refers to scaling and root planing per quadrant when four or more teeth are involved. Coding expert Estela Vargas shares her tips for ensuring you get paid for crowns, a common denial scenario, and a sample letter to use if you need to appeal a claim. Apr 4, 2025 · Crowns Scaling and root planing (SRP) Periodontal maintenance Core buildups Occlusal guards Palliative (emergency) visits Endo retreatments Extractions with complications If it’s not routine—and it costs more—insurance will want proof. Be sure to include the quadrants/tooth numbers affected, and make note of their pocket depths and any evidence of bone loss, if applicable. The patient has bob, inflammation, unattached gingiva, with puffing interdental papilla, 5mm pockets in each quad or higher, sub and supra calc with tartar, poor oh. Apply to Process Technician, Asociado De Autopago, Logisitics Manager and more! Depending on your unique case, you may be a candidate for non-surgical periodontal treatment. It also provides for isolated scaling and root planing where indicated. Probing depths range from 5-7mm on teeth #27-31 with 1-2mm of attachment loss. After getting the procedure and paying my portion of the cost I now get a letter in the mail from my insurance saying their reviewing dentist determined the xrays didnt show enough bone loss that If a patient completes nonsurgical treatment of their periodontal disease with scaling and root planing, the management of their condition is treated and correctly identified as periodontal maintenance for each subsequent appointment. The CDT Code fully supports documentation and reporting of procedures at any time the dentist determines they are necessary for the patient’s oral health. Nov 9, 2024 · The Healing Process: An Overview After undergoing scaling and root planing, patients can expect a range of healing timelines based on several factors, including the severity of gum disease, individual health conditions, and adherence to post-procedure care instructions. Oct 19, 2024 · They were found to leave an uneven root surface, and thus it was thought that manual root planing was required following ultrasonic scaling to smooth the root surface. Based on the patient's clinical presentation, I placed ATRIDOX® (doxycycline hyclate) 10% in each of the pockets listed below: Mar 17, 2025 · If the insurer disputes the necessity of treatment, a letter of medical necessity from the dentist can clarify why scaling and root planing was required. Indirect restorations Checkup and gums, scaling root planing letter from one or necrotizing periodontal disease has two and facilitation of consent and equitable settlement of revenue. Jul 31, 2023 · Common concerns reported to the ADA by member dentists are denials for scaling and root planing claim submissions. Failing to personalize the appeal letter can make it less persuasive. Most dental professionals agree that some of the most denied insurance claims are for scaling and root planing (SRP). The MassHealth agency pays for periodontal scaling and root planing once per member per quadra t every three calendar years. When it comes to periodontics details are the true name of the game, especially when it comes to scaling and root planing. Clinical Indications Scaling and root planing is a nonsurgical procedure meeting generally accepted standards of dental care for the treatment of mild to severe periodontal disease. Discover expert strategies to handle denied dental insurance claims. Oct 26, 2024 · In this article, we’ll provide you with 15 sample letters of appeal for dental claims that you can use as templates or inspiration for your appeal. Mar 7, 2025 · This code refers to periodontal scaling and root planing, a non-surgical procedure aimed at treating gum disease and preventing its progression. No login required. I understand that without a periodontal scaling and root planing my condi on will not improve and could possibly worsen, causing poten al tooth and bone loss. Nature of the Recommended Treatment It has been recommended that I have the following periodontal treatment (all that apply have been checked for me): Scaling and root planing Osseous (bone) surgery and recontouring Gingivectomy (recontouring) Periodontal bone graft Soft tissue graft Referral to a gum specialist (periodontist) Other: Scaling and root planing has been recommended to clear away the toxins causing inflammation and follow-up periodontal care has been recommended at three or four month intervals. deep cleaning for gum disease. WebThis means that there is a larger than normal pocket between the gums and the tooth due to bone loss in the area. Looking for free Appeal Letter Word templates? Access pdfFiller’s largest libraryof pre-built form templates in MS Word. Periodontal scaling and root planing claims tend to have a higher frequency for denial than other procedures, prompting many calls from frustrated dentists to the ADA asking why certain claims were denied. In this blog, we explain the scaling and root planing procedure, a common treatment for gum disease. Some templates I find that all new patients know what “deep cleaning” is, but don’t understand the term, “scaling and root planing. Apr 28, 2022 · Periodontics, including scaling and root planning When submitting periodontic procedures D4210 through D4212, D4240 through D4245, D4260 through D4285, D4341 through D4342 or D4381, you must include bitewing radiographs taken within 12 months of the planned treatment that show both arches of bone levels. However, these procedures do have limitations. Feb 13, 2025 · Scaling and root planing, or deep cleaning, is a specialized dental procedure to treat periodontal disease (gum disease). Feb 22, 2025 · I’ve honed my ability to turn insurance denials into successful appeals for friends, family, and clients alike. Sep 30, 2019 · The procedure is most accurately coded as D4341 - Periodontal Scaling and Root Planing, four or more teeth per quadrant or D4342 - Periodontal Scaling and Root Planing - one to three teeth, per quadrant. have attached the following documents relating to this treatment and the patient's history: Patient periodontal Denial of claims for periodontal scaling and root planing: a key issue for dentists. American Dental Association defines periodontal scaling and root planing (SRP) as “a definitive non-surgical periodontal treatment involving the judicious and thorough planing of the root surface. Scaling and root planing (SRP), commonly known as deep cleaning, requires specific patient consent due to its invasive nature and potential for discomfort. PerioChip® is indicated as an adjunct to scaling and root planing procedures for reduction of pocket depth in patients with adult periodontitis. Scaling and root planing is a non-surgical procedure that aims to remove plaque, tartar, and bacterial toxins from the tooth surfaces and root areas. An effective documentation process is crucial for maintaining accurate patient records, ensuring continuity of care, and meeting legal requirements. 거부를 뒤집는 17개의 무료 템플릿, 팁, FAQ 및 비디오. I am declining the op on to have the periodontal cleaning done, thereby relieving (Health Center) and any of the providers of any liability, should these condi ons develop. We can also efficiently manage your insurance verification and prior authorization needs. Mar 26, 2018 · The ADA Council on Dental Benefit Programs recommends these tips for minimizing claim denials or delays for scaling and root planing: Before submitting a claim for scaling and root planing, check the company’s guidelines on their website or in the provider’s office reference guide. When non-surgical treatment does not achieve optimal periodontal health, your periodontist may recommend gum surgery. Oct 19, 2022 · One of the most common denials from insurance plans is for crowns. Below are 15 detailed sample appeal letters to guide you through effectively requesting reconsideration or additional support. East, I am writing to appeal the denial of my claim number 789 for my root scaling Scaling and root planing (SRP) aim to remove bacteria and infection from the soft tissues around the gums. Scaling and Root Planing In scaling and root planing, your periodontist will perform a deep cleaning of your tooth root surfaces. Incorrect modifiers may result in the denial of coverage. MassHealth put forth credible testimony from a licensed dentist who reviewed the prior authorization request and X-rays and concluded that X-rays of the upper right quadrant reveal only 3 teeth with significant D4341-Periodontal Scaling and Root-Planing, per quadrant, is described as involving "instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces. D4341 periodontal scaling and root planing – four or more teeth per quadrant D4342 periodontal scaling and root planing – one to three teeth per quadrant Dental claims can be denied, delayed or alternate benefited for a myriad of reasons. Periodontal scaling and root planing involves instrumentation of the crown and root surfaces of teeth to remove plaque and calculus. Treatment initiated included scaling and root planing and oral hygiene instruction. Sample Letter To Appeal A Decision SampleTemplatess SampleTemplatess Scaling And Root Planing Appeal Letter Coding for scaling and root planing. Looking for a strong SRP appeal letter please. Jul 12, 2025 · Navigating insurance denials for scaling and root planing can be stressful and overwhelming. This is a matter of clinical judgment Jul 20, 2023 · In our last article, “ Dental insurance claim reimbursement: Clinically optimizing scaling and root planing,” we discussed the nonnegotiable requirement for scaling and root planing insurance claims reimbursements: visible bone loss. Most periodontal scaling and root planing claims are denied due to insufficient supporting documentation. Learn how to bill successfully for SRP at your practice. Periodontal scaling and root planing is the removal of calculus, bacterial plaque, bacterial toxins, diseased cementum (the outer covering of the root surface) and diseased tissue from the inner lining of the crevice surrounding the teeth. A scaling and root planing procedure is only recommended for people who have been diagnosed with periodontal (gum) disease that has caused bone loss. Apr 8, 2024 · Scaling and root planing have been standards in nonsurgical treatment for decades, but many claims are still denied. Jun 2, 2024 · I’ve written countless dental insurance appeal letters and understand the nuances required to craft a compelling argument. Each one addresses different scenarios and can serve as a starting point for your appeal. A proper appeal involves sending the plan a written request to reconsider the claim with any additional information. This applies to any patient whether the scaling and root planing is completed in your practice or elsewhere. Periodontist, This letter is to introduce our patient, Jack Smith, to your practice. ” Remember, once they’ve been informed and made a decision and you’ve documented that, you are not at risk. These phrases are often confused because they have a similar spelling. I’ve seen firsthand how a well-crafted medical appeal letter can change a claim’s outcome. Appeal Letter Sample This is a sample of an appeal letter that resulted in the claim being paid at the maximum allowable; the names of the parties involved have been removed. Smith was first seen in our office in January 1995, as a new patient. Try Now! Scaling and Root [Planing] is necessary to remove subgingival microbiota both alive microorganisms and dead to prevent further bone loss. The MassHealth agency pays for periodontal scaling and root planing once per member per quadrant every three calendar years. With a little guidance, that frustration can be appeased and those denials can turn into payments. I attended a seminar that suggested narratives for scaling and root planing claims (SRP) should list bleeding, loss of connective tissue, and active disease process. Background and perspectives from the ADA. X-ray images assist in making the tarter build up under the gums more visible. Receding gums are the scaling root appeal letter was not cleaned. I would appreciate a reconsideration of the claim from (date of service) for (Patient name). Edit, download, and share them online! tal Scaling and Root Planing. Mention the use of local anesthetics and describe the scaling and root planing process in detail. What dental code is being submitted for each quadrant? What necessary additional information is needed in order for the claims department to process this claim? Apr 25, 2023 · Learn how to write a dental appeals letter to your insurance company for denied claims. The MassHealth agency does not pay separately for prophylaxis provided on the same day as periodontal scaling and root planing or on the same day as a gi Scaling and root planing All the information we’ve discussed so far is related to indirect restorative treatment. Do SRPs need pre-authorizations and referrals Immediately following each scale and root planing appointment, it is normal to experience minor swelling and bleeding in the area which should subside on its own within a few days. Generally, the healing process can be broken down into several key phases: Here is a sample letter that would precede this patient to the specialist (along with the full mouth series of radiographs): Dear Dr. By the end, you’ll have the tools and confidence you need to challenge your insurance company’s decision and get the coverage you’re entitled to. Default CliniCal note templates The following is a list of all the default clinical note templates that are included with Dentrix. Periodontal disease, if left untreated, can lead to severe complications, including tooth loss and systemic health issues. Can a patient who received the D4346 scaling procedure then receive a D4341 (or D4342) scaling and root planing procedure? ease may be progressive. Special dental benefits and planing appeal letter will scrape plaque and the department. The objective of these non-surgical procedures is to remove etiologic In the complex world of dental billing, mastering the art of crafting effective claim narratives can make the difference between timely reimbursement and prolonged headaches. If you develop a severe gum disease called periodontitis, you may need tooth scaling and root planing to remove tartar and treat inflamed gums. Dentists may not always understand why claims for SRP are denied when the patient has abnormal pocket depths. Scaling, root planing and diabetes. It involves removing plaque and tartar buildup from the teeth and their roots, as well as smoothing the surfaces of the roots to prevent further bacterial growth. Over the years, there have been many modifications in the instruments, including smaller tip diameters, longer working lengths, different angles, and diamond coatings. Learn common reasons for denials for SRP and associated procedures and how to avoid them. Keep the periodontal chart for your record; however, submittal is not required. Additionally, our guideline titled Risk Management Strategies for Informed Consent contains valuable information regarding when and how informed consent should be obtained before commencing treatment. Template 1: Denied Claim Appeal Letter [Your Name] Apr 28, 2025 · If you’ve been denied rental assistance or need to appeal for more help, writing a strong, clear appeal letter can make all the difference. We would like to show you a description here but the site won’t allow us. It involves cleaning below the gum line to remove plaque, tartar, and bacteria that cause inflammation and infection. Dr. The Appellant testified that she, after consultation with her dental provider, was seeking procedure Dec 27, 2024 · Dental professionals often need a systematic record of patient information and treatment details. Feb 26, 2025 · Scaling and root planing Record pocket depths, areas of bleeding, and the presence of calculus for periodontal procedures. Each includes strong clinical justification language, CDT coding, and an attachments checklist. This article provides tips and guidance on how to craft a strong and effective appeal letter. These deep-cleaning procedures chip off tartar that hardens to the surfaces of your teeth and roots. The reason for the denial was stated as “no apparent evidence of bone loss. Learn how dental scaling and root planing help treat gum disease, what to expect during recovery, costs in the USA, and why it’s more than a regular cleaning. A comprehensive consent form serves multiple purposes: it educates patients about the procedure, outlines potential risks, and provides legal protection for your practice. Within each category, the template name and note text for each default template is listed. Root planing/scaling risks WebThe patient did some research and wrote this dental insurance appeal letter sample. First Treatment of periodontal disease may include periodontal scaling and root planing, either as a therapeutic procedure or preliminary to more extensive treatment. Understanding whether Delta Dental covers deep cleaning depends on factors like your plan’s benefits, your dentist’s network status, and how the claim is processed. Feb 5, 2024 · For each of these templates, ensure you attach all relevant documentation, including medical records, detailed treatment plans, letters from your healthcare provider, and any prior correspondence with the insurance company. Find periodontal treatment near you with top dentist Boston at Pondside Dental Associates. Scaling and root planing is a common and highly effective treatment for gum disease, particularly in its early to moderate stages. Bacteria and plaque are less likely to stick to the smooth surfaces of your treated teeth. Anyone who wishes to contest or seek a review of a decision can file a sample appeal letter, including individuals, organizations, or entities affected by that decision. Get Your Scaling and Root Planing Covered: Appeal Letter Tips Scaling and root planing (SRP), also known as deep cleaning, removes bacteria above and below the gum line when inflammation and bone loss are present, known as periodontitis. After getting the procedure and paying my portion of the cost I now get a letter in the mail from my insurance saying their reviewing dentist determined the xrays didnt show enough bone loss that Most dental professionals agree that some of the most denied insurance claims are for scaling and root planing (SRP). Dec 13, 2021 · Scaling and root planing, or SRP, has a higher-than-average denial rate. The MassHealth agency does not pay separately for prophylaxis provided on the same day as periodontal scaling and root planing or on the same day as a gi Looking for free Appeal Letter Word templates? Access pdfFiller’s largest libraryof pre-built form templates in MS Word. The patient had heavy deposits, severe gingivitis, inflammation, unattached gingiva, 5mm pockets or higher, and tartar. Example: For scaling and root planing, you may need to specify whether the procedure was done on a quadrant basis or as a full-mouth treatment. Here are some tips on what to do to get your SRP claims paid. Scaling and root planing was needed to treat the patient's gingival migration, bone loss, and severe deposits through anesthesia. ” Please review the radiographs as there is obvious, moderate-severe bone loss in all quadrants. Each template addresses different scenarios to help you articulate your appeal effectively. Oct 25, 2021 · (B) Periodontal Scaling and Root Planing. Upon examination, periodontal pockets sites were found of 5mm or greater. ” Generate professional and effective appeal letters instantly with our free AI-powered Appeal Generator. Offering actionable tips and insights to appeal for optimal reimbursement and practice success. Nov 8, 2025 · Here are 17 detailed, ready-to-paste appeal letter templates for denied Scaling & Root Planing (SRP). The MassHealth agency does not pay separately for prophylaxis provided on the same day as periodontal scaling and root planing or on the same day as a gingivectomy or a gingivoplasty. This area was scaled & root planed again and a "perio chip"- chemotherapeutic agent was placed in an effort to reduce the sub gingival flora. Based on the patient's clinical presentation, I placed PerioChip® in each of the pockets listed below: Tooth # Site Treated (MB B DB ML L DL) May 1, 2025 · Scaling and Root Planing Example 1: Localized moderate to severe periodontitis "Patient presents with generalized bleeding on probing and localized moderate to severe periodontitis in lower right quadrant. This specialized procedure effectively treats gum disease and helps maintain long-term oral health by addressing bacteria and tartar buildup both above and below the gum line [1]. Mar 15, 2025 · Deep cleaning, also known as scaling and root planing, is often recommended for patients with gum disease, but coverage varies by provider and policy. Jul 20, 2023 · In our last article, “ Dental insurance claim reimbursement: Clinically optimizing scaling and root planing,” we discussed the nonnegotiable requirement for scaling and root planing insurance claims reimbursements: visible bone loss. Jun 25, 2025 · Below is a practical example of an insurance appeal letter that dental offices can adapt for their own use: We are writing to formally appeal the denial of claim # [Original Claim Number] for [Procedure Description, e. This process can be daunting, but with the right approach and understanding, you can effectively communicate your needs and concerns. , D4341 – Periodontal Scaling and Root Planing] performed on [Date of Service]. The list is broken down by category. Unless you have previously customized your clinical note templates, your database should include these default templates. Optional Narrative: The patient has BOP (Bleeding on Probing), inflammation, unattached gingiva, with puffing interdental papilla, 5mm pockets in each quad or higher, sub and supra calc with tartar Oct 26, 2023 · Take the guesswork out of your scaling and root planing (SRP) dental insurance claims. Our guide explores tips and tricks to help you create a winning appeal and increase your chances of getting coverage for your dental treatments. True False Short Answer Section A patient is having scaling and root planing done (4 or more teeth) in all four quadrants of his mouth. Nov 11, 2025 · Explore 17 expert dental appeal letter samples to help you successfully challenge insurance denials and secure your dental benefits. MassHealth denied Appellant’s request for approval of the prior authorization request for periodontal scaling and root planing on all four quadrants of the Appellant’s mouth. Example/Claim Narrative - PerioChip Treatment initiated included scaling and root planing and oral hygiene instruction. Consider using such verbiage as “Patient presents with periodontal disease including BOP, exudate, (if present) mobility, and generalized 4-6 mm periodontal probing depths. Dominique Fufidio shares which codes to use and what to include in your narrative for SRP.