There’s a Code

Last fall, the American Dental Association (ADA) developed a new insurance code that dental hygiene professionals have long wished for. Code D4346, “Scaling in the Generalized Presence of Moderate or Severe Gingival Inflammation—Full Mouth, After Oral Evaluation,” became effective on January 1, 2017. We’ve all experienced the dilemma of what to bill for the so-called “bloody prophy.” It’s not really a prophylaxis, as the bleeding and inflammation are indicative of an unhealthy state. It’s not periodontitis because bone loss is not visible on radiographs. So clinicians have done their best to determine how to classify such patients, knowing that their best wasn’t quite right.

Third-party payers and other oral health organizations—such as the American Dental Hygienists’ Association (ADHA)—were actively involved in developing code D4346. The ADA has published a guide to help clinicians understand when and how to use the code.¹ According to the guide, the new code is designed to eliminate “undercoding” treatment procedures by using the prophylaxis code and to reduce “overcoding” by using a scaling and root planing code. Some additional specifics about code D4346 include:

• It is a full-mouth procedure code, but individual patient needs may require more than one visit.
• It is not used for localized gingival inflammation, but generalized inflammation throughout the mouth. The American Academy of Periodontology’s definition of generalized disease is used, and the Loe and Silness Gingival Index determines the degree of inflammation.
• Periodontal charting to show pseudo pockets and bleeding on probing is required for documentation.
• As with other services, the frequency and amount of reimbursement will likely vary among dental benefit plans.

While this new code is important in order to accurately bill for treatment, the true value of code D4346 is that it enables dental hygienists to better educate patients about their disease status. It’s one more tool that helps us move from “we need to watch that bleeding” to “we need to treat your early signs of disease.” Its addition to the Current Dental Terminology set of codes is beneficial for clinicians and patients alike.

— Jill Rethman, RDH, BA
     Editor in Chief
   jrethman@belmontpublications.com

Reference

1. American Dental Association. A Guide to Reporting D4346. Available at: ada.org/en/~/media/ADA/ Publications/Files/CDT_ Code_D4346_Education_Guidelines. Accessed March 16, 2017.

From Dimensions of Dental Hygiene. April 2017;15(4):8.