Dental Hygienist FAQs

I have been told that an oral evaluation cannot be charged to a patient on the same date as D4355 full mouth debridement. Is it legal for a hygienist to perform this treatment without the dentist also performing and charging an evaluation on the same date of service?

The dentist must diagnose the need for D4355. This can be accomplished during a brief encounter with the patient where treatment is prescribed but a full exam is not completed, and therefore, not billable to the patient. Documenting this patient encounter in the patient’s chart fulfills K.S.A 65-1456 allowing the hygienist to perform D4355. Completion of the comprehensive oral evaluation should follow the full mouth debridement on a subsequent date giving the debrided area sufficient time to heal/react to the D4355 treatment so that a full oral evaluation can be performed.

The full nomenclature and description is as follows:

“D4355 full mouth debridement to enable a comprehensive oral evaluation and diagnosis on a subsequent visit.”

Full mouth debridement involves the preliminary removal of plaque and calculus that interferes with the ability of the dentist to perform a comprehensive oral evaluation.  Not to be completed on the same day as D0150, D0160, or D0180.

My supervising dentist has two practice locations. Can a hygienist work without "direct supervision" in one office while the supervising dentist is working in the other office?

Yes.  A hygienist may work under "general supervision" as long as the patient is not a new patient, the supervising dentist has completed an examination during the 12 calendar months preceding the performance of the procedure, and the hygienist does not perform other prohibited procedures or functions.  K.S.A. 65-1456(d).

If the supervising dentist is out of the office but a dentist in another practice is covering emergencies can the hygienist continue performing prophylaxis on patients as long as the supervising dentist performed an examination on the patient during the past 12 calendar months?

Yes.  A hygienist may work under "general supervision" as long as the patient is not a new patient, the supervising dentist has completed an examination during the 12 calendar months preceding the performance of the procedure, and the hygienist does not perform other prohibited procedures or functions.  K.S.A. 65-1456(d).

Can a hygienist perform a scaling and root planing with anesthetic when the supervising dentist is not physically present in the office?

No.  K.S.A. 65-1456.

If the supervising dentist is not physically present in the office, but the dental hygienist or assistant takes x-rays and gathers all the patient information, can the dentist bill for an examination when reading the x-rays on a later date or does the examination have to include a "hands in mouth"?

The dentist must complete a "hands in mouth" examination to bill for any form of evaluation - comprehensive, periodic, or problem focused.  The radiographs should not be billed until they are read and interpreted by the dentist.