Revised 2015 ADA code for Osseous Surgery

[mcassity]

With the revised ADA code for 2015, any suggestions for coding LANAP surgery? We have already ran into one dental insurance that specifically states LANAP does not fall into osseous surgery as defined by ADA and the patient will be totally responsible for surgery if LANAP is used.

[byoung]

Here is my current personal template. I have borrowed from others. Feel free to borrow ideas here as well. Obviously you will make it your own based on specifics of individual cases.

Osseous regeneration surgery full mouth.
Premedicated with 800mg Ibuprofen.
4% Articaine with 1:100,000 epinephrine X 4 carpules per quadrant delivered over two hours.

Oral Sedation with Halcion 0.125mg with two tablets taken 90 minutes before procedure.
Third tablet taken at start of procedure.
Start BP 137/86 P 115
End BP 144/90 P 106
Oxygen delivered by nasal canula at 3 L/min.
Monitored BP and oxygen saturation by pulse oxymeter every 15 minutes.

Bone sounding measurements obtained.
Full thickness gingival flaps.
The CEJ, root surface and apical bone were accessed.
Scaling and root planing accomplished with ultrasonics and hand instrumentation.
Bone modification at osseous crest with sharp dissecting instruments.
Flap replacement and wound closure by pressure application.
Wound stabilization by occlusal adjustment.
Extracoronal anterior splint fabricated and delivered to eliminate heavy occlusal contacts at night for the next few weeks.
Final orthotic device will be fabricated shortly.
splinting and/or splint therapy.

Post surgical instructions written and oral.
Liquid diet X 3 days then soft mushy diet X 7 more days.
RX: Amoxicillin 500mg disp 30 caps, Sig: Take one cap tid until gone.
RX: Peridex one bottle. Sig: Rinse/spit 30 seconds bid until gone.
Patient to take Ibuprofen 800mg on schedule q8h for 2-3 days, then taper back.
For pain not controlled by Ibuprofen, take Tylenol 1-2 tabs q 4-6 h.

Laser assist for this procedure followed established LANAP guidelines and laser information is as follows:
Laser: FR Nd YAG (PerioLase)
Power: 4.0 Watts.
Total Joules:3610. Average 144 Joules/tooth.
Pulse first pass: 100 microseconds for troughing, removing inflamed pocket epithelium and to kill pigmented bacteria within preserved tissue.
Pulse second pass: 550 microseconds for hemostasis.
Biostimulation 400 Joules.

Next: First POT in 1-2 weeks.

[Author]

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