26 Mar Revised Codes for 2018 includes the notorious “full mouth debridement” code D4355
An air of mystery has always shrouded using the “full mouth debridement” code D4355. Many insurance plans don’t pay for it at all or pay it once in a lifetime or count it as a regular cleaning(prophy)??? Which it is not.
To clarify it’s usage the ADA has decided to revise it’s verbiage to make it clearer as to the intent of the code.
The nomenclature of D4355 has been revised to add the phrase “on a subsequent visit”. This is to make clear that a comprehensive oral evaluation and diagnosis are performed at a subsequent visit following the full mouth debridement procedure, not on the same date of service. The phrase “the gross removal” of plaque has been replaced with “full mouth debridement involves the preliminary removal” of plaque and calculus—the patient may or may not have periodontal disease. That remains to be determined by the subsequent full comprehensive evaluation appointment on another day. Following the full mouth debridement appointment a comprehensive oral evaluation (D0150) or (D0180) and either a prophylaxis (D1110) or SRP (D4341 or D4342) may be performed on a subsequent date, depending on the diagnosis.