Refusal of periodontal therapy - D4910 vs D1110

Question

I have a patient who is refusing SRP, but the doctor would like to continue treating the patient. D4910 doesn't apply since the patient has no history of periodontal therapy, but they are receiving more than a routine D1110. Is there an appropriate code that can be submitted to insurance in this situation, or is there an accepted ''in-between'' code that would be more appropriate? We had the patient sign a refusal of treatment form so we're wondering if we can just technically do a "prophy/D1110" according to the prophy description, letting the patient know that we aren't giving them the full cleaning needed for their diagnosis.

Staylor2964 · Answer

Yes, that is correct. You cannot bill D4346 because that does not meet the clinical criteria and D4910 cannot be coded. That can only be billed after SRP is completed. If the patient is refusing any treatment it should be documented in their chart. Also, I would recommend having them sign a denial of dental services/refusal of treatment form stating they are aware of the treatment plan, but are refusing that treatment. That protects the dental office.

Austinida · Answer

Hi! Per CDT 2026, there is no "in between" code between D1110 and D4341/D4342. D4910 requires previous perio therapy and wouldn't be appropriate to apply in this case. A potential alternative code is D4346, but that code has specific clinical criteria and would not be used simply due to the pt refusing SCRP. If the pt is refusing diagnosed perio treatment, I would highly recommend having this documented in the pt chart.

Refusal of periodontal therapy – D4910 vs D1110

Refusal of periodontal therapy – D4910 vs D1110

Answers (2)

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