In 2017, after several years of hard work by a dedicated team of dental hygienists, the American Dental Association’s Code Maintenance Committee voted to approve procedure treatment code D4346 – escalation in the presence of generalized moderate to severe inflammation – full mouth, after oral evaluation . Prior to the creation of this new procedure code, dental professionals were stuck using either D1110/01120—prophylaxis—adult/child or D4341/D4342—periodontal scaling and root planing.
Code D1110 is a preventive procedure code designed for patients with good oral health or localized areas of gingivitis. On the other hand, D4341/D4342 is a therapeutic procedure code for patients who require periodontal therapy to treat active periodontal disease, which includes bone loss and attachment loss.
Completing blank code
There was always a “gap” in the code set until the D4346 was created. For patients who have more than localized gingivitis, but no bone loss, D4346 does a great job of filling that gap. Using the new code, practitioners are less likely to “undercode” using a prophylaxis for the patient with moderate to severe gingivitis or “overcode” using the periodontal therapy code when, in fact, the patient has no bone. loss.
The ADA has created a guide to using this new code, including a decision tree. Information from that document was used here.1
D4346 has no frequency restrictions according to the description: “Indicated for patients who have swollen, inflamed gums, generalized supraosseous pockets, and moderate to severe bleeding on probing.” The dental provider must determine when a patient still needs this curative procedure versus when they can return to a preventive prophylaxis procedure.
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You may be asking, does insurance cover this code? However, as is often the case, third-party payors may have coverage limitations or exclusions that will eliminate or limit refunds. Remember that just because their plan doesn’t cover the procedure, doesn’t mean they don’t need the procedure. Dental benefit plans do not always cover everything needed for a patient’s treatment. If a patient still has moderate to severe inflammation when they return, then D4346 is still the most accurate procedure code to continue to report, regardless of benefit coverage.
The ADA recommends that any claim using procedure code D4346 provide a lot of supporting information. The first is whole-mouth periodontal mapping that includes pocket depths, bleeding and recession to a minimum. Clinical attachment loss is usually modeled by the software once the probe depths and recession have been written. X-rays showing the bone levels of all teeth are also required. Adding intraoral photos is a great way to show the amount of inflammation that is present. And, of course, clinical notes describing the diagnosis provided should always be included.
We now have a way to accurately select the appropriate treatment for our patients with moderate to severe gingivitis based on their diagnosis. It is important to perform our hygiene assessment, establish the diagnosis together with the dentist (if required) and then select the most appropriate procedure code for that diagnosis.
The ADA’s basis for determining the correct CDT procedure code has always been “code for what you do” and “treatment planning is based on clinical need, not covered services.”2
bibliographical references
1. ADA Guide to Reference D4346. American Dental Association. January 1, 2023.
2. CDT 2023 Coding Companion. American Dental Association. 2023:16.
Editor’s Note: This article appeared in the August 2023 print edition RDH magazine. Dental hygienists in North America are eligible for a free print subscription. Register here.
