A game changer: 2017 will bring a new CDT code for gingivitis
The long-awaited code won't go into effect until 2017, but it's important for dental practitioners to understand it now.
Your patient presents with inflamed, hemorrhagic gingiva, light to moderate subgingival calculus, light supragingival calculus on the mandibular lingual anteriors and generalized pseudo-pocketing. For all of the history of Current Dental Terminology (CDT) coding, there have been no truly accurate codes that can be used for the treatment this patient needs. In 2017, that story will change. Yet, we must guard against misuse of this new code and not miss the disease present.
No clinical attachment loss, from the CDT coding perspective, means non-surgical periodontal codes (D4341/D4342) don’t fit. Coding for a full mouth debridement (D4355) isn’t appropriate either, as a full mouth debridement is indicated when a comprehensive evaluation cannot be completed due to excessive plaque, calculus, and debris. However, coding for an adult prophylaxis (D1110) doesn’t seem appropriate. There is D4999 unspecified periodontal procedure, by report but that doesn’t seem right either. The only choice has been D1110 because there simply isn’t a CDT code that satisfies the treatment needed for their oral condition.
However, January 2017 will bring us a new CDT code for patients who present with moderate-severe gingivitis! While this code has passed through the ADA Code Maintenance Committee (CMC), it has of yet been given a CDT Code number and can’t be used until after 1/1/17. Insurance companies may take a few months to recognize this new code or that it will covered under their policy. The existence of code does not mean a patient has coverage under a policy. Yet without a code, no coverage could be offered.
The code passed the CMC reading this way:
Nomenclature (Name): Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation.
Description: 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. Should not be reported in conjunction with prophylaxis, scaling and root planning, or debridement procedures.”
Minor tweaks in this verbiage may still happen. Let it be noted: YOU CAN’T USE THIS CODE YET BECAUSE IT DOES NOT YET EXIST! (Yes, we are yelling to be sure everyone hears that part.)
Why do we need the code? Find out on the next page...