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- Debbie Seidel-Bittke, RDH, BS, Speaker, Author. Dental Hygiene Coach & Consultant

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To Charge or Not to Charge. Oral Cancer Screenings

By: Debbie Seidel-Bittke, RDH, BS

March 13, 2017

Oral Cancer Screening

Video: Oral Cancer Screenings. To Charge or Not to Charge


Years ago, the dilemma that most dental professionals faced was regarding whether to use advanced technology to screen for oral cancer.

Today’s Facts: The occurrence of oral cancer has continued to rise and has begun affecting a younger demographic, due to a staggering increase in the prevalence of human papillomavirus (HPV). Fluorescent technology for early discovery of this growing epidemic has continued to evolve. Adjunctive devices have been simplified and very cost-efficient. My preference is the OralID because of the light weight and small size of the device. This technology makes oral cancer screening a no-brainer.

The questions that continue to repeat in the dental clinicians mind is:  “Should we charge for this or not charge?”

Once the dental team has decided to charge the next questions are:
“How much do we charge our patients for this enhanced oral cancer screening?”
“Do we only bill insurance, or do we screen for free as a service to our patients?”

The great news is: With the latest device having zero cost per patient use, you can incorporate the technology with whichever answer to the question fits your practice best.

Below, I will outline a few examples on ways to incorporate enhanced oral cancer screening into your practice.
To Charge
Charging for services performed is standard in health care. As you invest in your practice, in terms of both time and money, it is natural to assume compensation will allow you to make a return on your investments. Enhanced oral cancer screening is a service you provide, and it is perfectly acceptable to expect an increase in revenue in return for the service.
How to charge for enhanced oral cancer screening can vary from office to office. Here are a few options for charging:
Charge an annual fee: You can simply charge a flat fee for your enhanced oral cancer screening. Set a fee of around $20 (or within a range of $10 to $35) per patient, per year. If you educate your patients properly, you should see fairly high acceptance rates in your office. But if you just hand a patient a consent form and ask for a $65 fee, you will not have any success. So, if you decide to incorporate this method, make sure that the fee is reasonable and that you have educated your patients about the importance of what you are doing. Explain that you have invested in the technology because it could potentially save their lives. OralID offers Lifetime Team Training by our in-house hygienist, so you can get help with ideas on how to best educate your patients and maximize screening acceptance.
Charge one fee for life: In the spirit of the “whitening for life” campaigns that some offices offer, you can charge up-front for participation in an “oral cancer screening for life” program. Charge $35 to $100 at the first visit and then screen the patient at no additional charge during future visits (as long as he or she does not miss any hygiene appointments, of course).
Raise your fees: Increase your exam and/or prophy fees to include the service and do not charge the patient directly for it. This allows you the freedom to screen every patient and compensates you for your time and for your investment.
Not To Charge
Dental practices are always looking for ways to differentiate themselves from competitors. Offering advanced oral cancer screenings is a proven method for increasing marketability and gaining new patients. Performing free oral cancer screenings for every patient is a service that will be appreciated by patients and that will not only get you more loyalty from current patients but also motivate them to refer friends and family-and this is the ultimate marketing goal.
You can hand a card to each patient that reads, “Has your loved one been screened for oral cancer?” or a coupon for a free oral cancer screening. Doing so will certainly differentiate your practice from the others, building value in the practice by maintaining and growing the patient base. The days of “whitening for life” are unfortunately over, but offices can now incorporate “oral cancer screening for life” for their patients due to the latest technology finally being affordable enough to make it possible.

CDT Code to Bill: D0431
A change in thinking
Patient care should be the focus for all offices. Given that, you may eventually change the method you choose in regard to charging or not charging. It’s not uncommon for offices to begin screening by charging for the service, only to decide not to charge after finding a lesion that might not have been discovered without the device. For many practices, a situation like this one is a practice changer that leads to the realization that enhanced oral cancer screening is important for every patient.
So, when you are thinking about the new screening decision, whether “to charge or not to charge,” remember that there is no right or wrong. By making the simple choice to incorporate this technology into your practice, you could be making a life-changing decision for your patients.

For more information on the OralID go to: ORALID MORE INFORMATION

Gingivitis Code: What You Must Do!

By: Debbie Seidel-Bittke, RDH, BS

February 2, 2017

The New Gingivitis Code D4346Welcome to 2017 and our new CDT Codes! The long-awaited gingivitis code has arrived and we should be jumping for joy!

But wait….You are saying you don’t think you should use the code? Yes, that is what we are hearing. Some of you are not sure insurance  will reimburse your patient for this service.

Gingivitis Code: What You Must Do!

What you must do it record in your patient notes what treatment you provided your patient.

BTW: Our clients who are utilizing the D4346 Code have received payment. The payment they  received was about or around the same amount as the reimbursement paid for D4910 – Periodontal Maintenance.

We know that some of the Delta Plans have made payment for this code as well as Blue Cross and a 3rd party umbrella plan “DHA” have all reimbursed for our clients who billed D4346.

Some of you may remember when we first had the fluoride varnish code. Not all insurance companies reimbursed for this insurance code when billed but as time passed and the more offices billed and insurance companies saw this code being submitted for payment, the more insurance companies began to reimburse for this service.

Bottom Line. Bill exactly what you diagnose treatment and then treat according to your diagnosis.

D1110 Definition

Prophylaxis is”only for people who do not exhibit any of the signs and symptoms of periodontal disease, including bone loss, bleeding, mobility, exudate, and recession.” It is for  “the removal of plaque, calculus, and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.”

D4346 Definition

“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.”

Video Gingivitis Code

Video Gingivitis Code

Legally you need to document a diagnosis. The next time you see your hygiene patient and make your diagnosis before you begin your patient care, be sure to match your diagnosis with Healthy, using one of these procedures or Disease, which indicates you begin or continue periodontal therapy.

Next time you question insurance payment for your hygiene patient care refer to these definitions for determination of your diagnosis and then treat accordingly.

We are in the business of helping our patients live a longer and healthier life. It is also our ethical and legal respsonsibility to treat our patients according to their diagnosis.

This is what we must do!

Got questions about  this new code? Yes, it can be confusing but here is what you can do now:

  • Grab our Free Resource on treating gingivitis
  • Once you grab this resource you will receive an invitation to join the webinar on Feb 21, 2107 with Dr. Roy Shelburne The coding and billing expert
  • Read our other numerous articles  written previously
  • Mark your calendar for February 21st at 5:30PM Pacific and plan to join me with Dr. Roy Shelburne as we discuss this topic in more depth.
One of Dentistry Today's top dental consultants

Debbie Seidel- Bittke, RDH, BS Dental Hygiene Consultant


Debbie Seidel-Bittke, RDH, BS is an international dental consultant, coach, speaker and author. She is also CEO of Dental Hygiene Solutions, powered by Dental Practice Solutions. Debbie is a world-class leader in creating highly profitable hygiene departments. She is a well-known former clinical assistant professor at USC in Los Angeles and a former hygiene department program director. Dentistry Today recognizes Debbie as a Leader in Dental Consulting for the past 12 yrs.

The New Gingivitis Code

By: Debbie Seidel-Bittke, RDH, BS

November 21, 2016

The New Gingivitis Code CDT D4346

Dentiist and Hygienist with Dental Patient Record

You probably have heard the news!

There is a new gingivitis code in 2017.

Thhe new gingivitis code is intended for patients who have moderate to severe gingivitis, inflammation and yet they do not have any signs of radiographic bone loss; no periodontitis.

Why was the procedure for “scaling in the presence of…generalized gingival inflammation” assigned a code in the CDT Code’s “D4000’s” (Periodontics) category rather than in “D1000’s (Preventive)?

Currently we have a code for healthy periodontium (D1110), codes for non-surgical periodontal therapy (D4341/D4342), a code for the maintenance of periodontally-involved patients who have undergone non-surgical periodontal therapy (D4910), and a code for gross-debridement (D4355).

We have never had a code to support insurance billing for a patient who does not fall into any of the above categories. The CMC has typically decided that gingival disease treatment should be coded using D1110 yet for many this has never made much sense.

The New Gingivitis Code 2017 is: D4346


The procedure is considered therapeutic for a patient in a diseased state, as noted by the following sentence in the D4346 descriptor – “It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing.”

When a patient is diagnosed with generalized gingivitis following an oral evaluation this scaling procedure treats the generalized gingival inflammation and pseudopockets present.

In our next blog I will answer why it’s important that hygienists understand how to use this new code.


 Click this link to watch video

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Dental Continuing Education

Dental Conference: January 2017, 6 CEU’s + More.

Do you want to have a “Team Driven” Practice? Be sure to register for our Live All-Day Events Beginning in January 2017:

REGISTER HERE Early Bird Pricing Expires December 5, 2016 and Group of 6 or more save even more!

When you attend:

We are going to sit down together and create your success blueprint and then your roadmap so that you are prepared to take any loop de loops and pin curves in stride. There is an unknown economy and I will be sharing ways to grow your nP #

How to get more patients to accept your care

How to get patients back on your schedule and then the 2 important things you can do to keep them returning to your office. There is so much more to tell you so head over to our event page:

One of Dentistry Today's top dental consultants

Debbie Seidel- Bittke, RDH, BS Dental Hygiene Consultant


Debbie Seidel-Bittke, RDH, BS is a dental consultant, coach, speaker and author. She is also CEO of Dental Hygiene Solutions, powered by Dental Practice Solutions. Debbie is a world-class leader in creating profitable hygiene departments. She is a well-known as a former clinical assistant professor at USC in Los Angeles and a former hygiene department program director. Dentistry Today recognizes Debbie as a Leader in Dental Consulting. She can be reached at (888) 816-1511. Send an e-mail to info@dentalpracticesolutions.com or go to her website: http://www.dentalpracticesolutions.com