We owe code D4346 to eight hygienists who came together to create a code that was missing from the CDT Code. Back then there were two precautionary codes (D1110 and D1120) in the preventive category. Treatment procedures such as scaling and root planing (D4341/D4342) were in the periodontal category. There were no procedure codes for treatment for patients with gingivitis without attachment/recession/bone loss.
The California Association of Dental Hygienists created a debridement task force in 2013. Their mission was to develop a relevant definition for D4355, full-mouth debridement. They also considered a new gingivitis-type procedure code to fill the gap.
The submission to the coding committee
Nomenclature: Scaling is performed in the presence of moderate to severe gum inflammation.
Descriptor: Scaling occurs in the presence of moderate to severe gingival inflammation without clinical attachment loss (recession, bone loss).
Logic: Dentists and dental hygienists promote regular dental visits to assess patients’ current dental condition and recommend preventive, curative and/or restorative treatment. When it comes to preventive and therapeutic procedures related to periodontal structures, the selection of the appropriate procedure code that reflects the appropriate treatment is limited.
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The steps to a code
The first step was to complete a code action request form for the code maintenance committee. One of the questions was: Does the request represent the official position of a dental organization or recognized dental specialty, a third-party payer or administrator, or the manufacturers/suppliers of the product?
The second step was to describe the rationale behind the request. This included the reasons why the existing procedure code was inadequate, a description of the technology inherent in the procedure and the dental schools where it is taught.
The group decided to expand on the reasoning and add: “Once preventive/periodontal treatment is determined, the selection of a procedure code should be either preventive (prophylaxis by adults) or periodontal (full body cleaning, scaling and root planing or periodontal maintenance if history SRP). There is currently no procedure code for a patient who presents with significant gingival inflammation and significant amounts of calculus and plaque but does not have clinical attachment loss, which includes recession and bone loss.
The third step was to provide additional supporting documents. This included references to articles, surveys, etc. The team completed the necessary paperwork for the revised D4355 as well as the new code they believed should be D1130 and submitted them. They then waited to hear if it was accepted to be presented at the code maintenance committee meeting on April 10, 2015. These were the first two code submissions ever made by a group of hygienists.
Since no one in the group had ever attended CMC, they did not realize that it would be beneficial to have someone there to represent them and give testimony and answer questions. Many of the voting CMC members had questions.
Since the submission was on a specific topic, CMC members decided to table it and refer it to an ad-hoc CMC working group for review and recommendation for action at the 2016 CMC meeting. This was another first for the hygienists.
What came next to create a code
The CMC Working Group met the following year and submitted the following for the 2017 CDT:
Nomenclature: D4346 — Desquamation in the presence of generalized moderate or severe gingivitis, full mouth, after oral assessment. This language is nearly identical to that submitted by the CDHA task force.
Descriptor: The removal of plaque, calculus and stains from the supra- and subgingival surfaces of teeth when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. Indicated for patients who have swollen, inflamed gums, generalized supraosseous pockets, and moderate to severe bleeding on probing. This should not be mentioned in conjunction with prophylaxis, scaling and root planing or cleaning procedures.
Logic: There is a CDT code gap. Current codes document treatment procedures for patients with a healthy periodontium or patients with periodontal disease who have accompanying attachment loss, such as periodontal pockets and bone loss. D1110 is a preventive procedure applied to patients with healthy periodontium. Codes D4341 and D4342 are curative and indicated for patients requiring scaling and root planing due to attachment loss. However, there is no CDT code available that reports the treatment of patients with gingivitis and no attachment loss.
This passed unanimously! The American Dental Association finally realized it was time to recognize the process and create a new code. The language of this new code was heavily influenced by the CDHA working group.
The CDHA should be commended for addressing this important aspect of dental hygiene services – language that adequately and accurately describes the services that hygienists provide to patients. Never before have dental hygienists had a direct impact on the development of a procedure included in the CDT manual.
Since 2016, the DentalCodeology Consortium has been working with hygienists to create new or revised submissions to be presented each year at the CMC meeting. At least one of the DCC directors is in attendance to answer questions. Although not all of their submissions have been approved, they appreciate the presence of dental hygienists.
Anyone can propose a new procedure code or an amendment to an existing code. The ADA has guidelines posted on its website. One of the goals of the DentalCodeology Consortium is “to develop and submit dental procedure code proposals (submissions) to the American Dental Association’s code maintenance committee at its annual meeting in March.” Hygienists CAN make a difference!
Editor’s Note: This article appeared in the January-February 2024 print edition of RDH Magazine. Dental hygienists in North America are eligible for a free print subscription. Register here.
Kathy S. Forbes, BS, RDH, has been a dental hygienist, educator, speaker, author, consultant, seminarian and study club leader for over 40 years. He holds a license in the ODA for Current Dental Terminology, which allows her to provide the most up-to-date understanding of existing procedure codes. Kathy currently serves as director for the Dental Codeology Consortium, reviewing and developing procedure codes related to dental hygiene practice that are presented to the American Dental Association’s Code Maintenance Committee in March of each year.
Connie Simmons, MA, BSDH, RDH, she earned her BSDH from The Ohio State University and her MA in aging studies from Wichita State University. He has worked in clinical hygiene for almost 35 years and has other roles in clinical education, sales, speaking and writing. Her knowledge of dental insurance and coding grew while working with an insurance carrier and is now a member of the Dental Coding Consortium and an associate productivity coach with Inspired Hygiene. He is also an expert in the clinical use of silver diamine fluoride. Reach her at [email protected].
