At the beginning of 2017, dental professionals were given a new code to properly code moderate to severe gingival inflammation with no clinical attachment loss. This code now bridges the gap between dental procedure codes D1110 (prophylaxis) and D4341/D4342 (scaling and root planing).
All dental hygienists have patients who present with inflamed, red gingival tissue, light to moderate calculus, and generalized pseudo-pocketing with no clinical attachment loss. Until now, we have only been able to code this patient's treatment as a D1110. We can finally correctly code treatment for patients with gingivitis.
According to the American Dental Association (ADA), the dental procedure code D4346 is defined as, "scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation. The removal of plaque, calculus and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. [It] should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures." It is important that dental professionals clearly understand and appropriately use the code in order to gain acceptance from insurance companies and patients.
Here are some quick facts about D4346:
It is important to explain to the patient what gingivitis is and that it is reversible if actions are taken in the dental office and at home. You should recommend home care products that best fit your patient's needs. For gingivitis patients, Colgate Total Daily Repair toothpaste is an excellent product recommendation. It helps to repair early tooth and gum damage and helps to prevent plaque and gingivitis, helping to keep gums healthy. Using the Gum Health Physical tool helps you create a customized report that describes product recommendations and contains a customized chart that shows where your patient needs to improve home care. Sending patients home with a visual representation of where their oral care is lacking may motivate them to adopt better habits.
Just because certain dental procedure codes exist does not mean the patient has coverage. Insurance companies may take a few months to recognize this code and develop terms and conditions for new CDT codes for each policy. It is our job as dental professionals to properly code each patient based on the findings during the doctor's exam and the care rendered by the dental hygienist.
It is crucial to understand dental codes because they enable dental hygienists to code correctly according to the care patients receive. The addition of D4346 fills the gap between prophylaxis and scaling/root planing, thus allowing dental hygienists to code appropriately for more precise insurance claims. Hopefully, the new D4346 code will result in reimbursement from insurance companies and better encourage patients to seek the dental care they require to treat their gingivitis.
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