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Patti DiGangi, RDH, BS, believes dentistry is no longer just about fixing teeth. Dentistry is oral medÂicine. Her work helps dental professionals embrace the opportunities and understand the metrics that accurate insurance coding provides. The ADA recognized her expertise by inviting her to write a chapter in its CDT 2017 Companion book and again for its CDT 2018 Companion. She is the author of the DentalCodeology series of easy-to-read, bite-size books. Her latest book, "Teledentistry: Pathway to Pathology" was co-written with Cindy Purdy, RDH, BS. She can be reached at email@example.com.
A periodontist recently wrote to me and said:
"I just used this D4346 code and submitted to Delta Dental of New Jersey. The patient was an 18-year-old male. No radiographic bone loss. I took photos that I submitted with the claim showing the gingival inflammation and hyperplasia. Now, I presumed that this code was what we had been asking for, that is scaling that is done when there is no bone loss but gingival inflammation. ... I was mistaken and anesthetized and did four quadrants of 'scaling.' Delta paid about what they would pay for a prophy, $96."
Sometimes there is a lag time between the CDT authorizing new codes and the insurance companies “getting the memo.” It has been one year since the D4346 gingival inflammation code was added to CDT 2017. This code was intended to close the well-known gap in periodontal care coding.
This periodontist put into writing the feelings and thoughts of many professionals. Dealing with dental benefits carriers regarding codes and coverage has once again lead to frustration and a feeling of helplessness.
New codes are often misunderstood and not covered under current contracts, and the fees are rarely covered at the level we would like to see. From a practice management and business point of view, the thought often becomes, “Why bother?”
There are many reasons to bother.
Click through the slides to find out four benefits of using the D4346 code.
1. Create data-based outcomes
Every dental professional sees gingival inflammation daily, whether it’s the hygienist seeing patients for routine care or dentists performing restorative care. We know the health of the gingival tissues is important with inflammation recognized as a catalyst of the oral-systemic link.
Yet our tradition has been to think and behave as if it is not significant until major destruction occurs. This behavior is somewhat akin to knowing a person has high blood pressure yet waiting until there is a heart attack and need for a stent before the disease process is viewed as serious.
From a perio perspective, before there is clinical attachment loss, there are signs and symptoms of oral inflammation. With the past gap in our codes, we have been treating disease with measures meant for prevention.
The D4346 code facilitates accurate coding for care that we have been performing routinely. The code creates a metric. Metrics can give us the power to quickly arrive at data-driven decisions that can improve outcomes and performance, drive cost savings, and enhance patient quality of care and satisfaction.
2. Ensure earlier intervention and disease prevention
This new code elevates our standard by identifying and treating periodontal disease in its earliest stages when intervention may lead either to an outright cure or a signiï¬cant reduction in damage.
A standard of care isn’t written in single document, nor is it decided by the care providers or third-party payers. Rather, it is most often decided in a court of law. Lawyers, judges and others would find the standard from a variety of sources.
A standard of care, in legal terms, is the level at which the average prudent provider would practice. It is how similarly qualified practitioners would have managed the patient's care under the same or similar circumstances.
D4346 elevates our standard of care, and we can now cure periodontal disease - not just manage it.
3. Boost the bottom line of the practice
Getting patients to come in for routine hygiene care is the most common business strategy used by dentists to attract and keep patients. Data shows us every day that loyalty connections don't hold the same sway as they once did.
Dental patients are consumers. Being due for a hygiene appointment no longer motivates the majority of consumers to make and keep these appointments. Savvy consumers need specific reasons to return.
We need to make sure our patients know the difference between preventive procedures intended to reduce the likelihood of disease and the care for gingivitis, a diseased state requiring treatment.
Treating gingivitis disease may help prevent or at least reduce the risks of death from oral cancers, pre-term births, stroke and heart attacks, diabetes and Alzheimer’s disease, to name just a few. This provides tangible reasons to return.
D4346 provides a way to consistently communicate the importance of treatment of early disease and oral-systemic connections. It gives our savvy consumer patients reasons to return to the practice, which will help boost the practice’s bottom line.
4. Improve patient co-management and earlier referral to periodontal specialists
D4346 helps us recognize early disease. Unfortunately, many of our clinical decisions appear to be arbitrary, uncertain and variable. It is not because we lack competence, sincerity or diligence, but because we must make decisions about tremendously complex problems with limited evidence.
We used to think we could or should remember everything we needed to know to practice. With the explosion in scientific literature, we need to finally give up on even thinking this is possible.
Periodontists receive extensive training, including three additional years of education beyond dental school. They are familiar with the latest techniques for diagnosing and treating periodontal disease and are also trained in performing cosmetic periodontal procedures.
Yet, as a whole, dentistry referred more patients to the periodontist in the last 20 years of the last century than we have in the first 15 years of this century. What’s more, when patients are finally referred, there is greater disease severity and tooth loss, which means greater systemic risk.
Working together as an interdisciplinary team, hygienists, general dentists and periodontists have the opportunity to increase healing and regenerative success, thus contributing to overall patient health.
This periodontist said, “You may want to add in your articles that this code is ‘full mouth’ not by quadrants.”
Knowing both the actual nomenclature/name of the code as well as the description is the first step:
D4346 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. Should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.
To make it simple, here are eight major focus points to consider when implementing D4346.
A plastic credit-card sized chairside safe reminder card with these eight focus points is available for free on DentalCodeology.com.
The difference makes a difference
We can finally treat gingivitis after decades of merely dumping gingival inflammation into the same category as health. This new code can potentially close the loop and elevate our standard of care. With increasing research pointing to the connection between oral disease and medical conditions, the timing is perfect. Early recognition ensures earlier intervention, disease prevention, working more successfully together and boosts the bottom line.