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Debbie Seidel-Bittke, RDH, BS is known as a top dental consultant by Dentistry Today.

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Gingivitis Code 2017

By: Debbie Seidel-Bittke, RDH, BS

November 28, 2016

64009034 – dental insurance form dentist concept

This month I have written a series about the New Gingivitis Code 2017.

This is music to the dental professional’s ears because daily we see patients who need more than just a prophylaxis.

Many dental hygienists heard grief from patients who needed to return for a second prophy before their normal six-month routine hygiene appointment. These patients were possibly concerned because their insurance would not pay for a second prophy prior to six-months. There are many hygienists who admit to just scheduling their overdue “Gingivitis” patient for a six-month appointment rather than concern patients with an additional payment and one that “God forbid,” their insurance would not pay for!

Now we have a new CDT Code that we can use to bill and hopefully, receive reimbursement for this procedure.

This code is very important for hygienists to understand.

What Hygienists Need to Understand About the New Gingivitis Code 2017:

This code is dependent upon 2 factors:

  1. Diagnosis

This means that the patient has a diagnosis that is “gingivitis” and not periodontitis.

This code is based on bone height or loss of: Gingivitis or Periodontitis.

Hygienists must measure the bone height. If your patient is healthy you will measure approximately 1.5-2mms when you measure from the alveolar crest to the CEJ.

You cannot render treatment unless you have a diagnosis.

  1. Documentation

It is imperative that you document all of your findings (include your diagnosis) and this needs to be completed while your patient is in your office; not after they leave; later that day or later that week (Sorry! I see this happening too often when I am in dental offices).

This code is CDT Code D4346 and you can begin using this for the indications listed above.

I believe this will breathe fresh air into the treatment rooms of dental hygienists!

What Will Hygienists Do Differently?

First of all, for clinicians who have been concerned about payment for their patients and for those clinicians who are worn out from patients complaining “But My Insurance Won’t Pay For That!!” you have a great answer.

First of all, I hope that before any clinician picks up a curet they pick up a probe to discover what the patients’ oral condition is.

  • Does your patient have BOP?
  • Does your patient have an excessive amount of calculus (Sub and supra)?
  • Does your patient use tobacco and require more than just a routine prophylaxis?
  • Does your patient have systemic conditions that require more than a prophylaxis?

Next is to communicate with your patient: knee-to-knee and eye-to-eye before you pick up your curet to let them know what you “see” in their mouth:

  • Does everything look healthy? Can you congratulate your patient on their great homecare?
  • Is there active disease? And if there is active disease how can you show your patient what is going on in their mouth? (i.e. radiographs, pictures, intraoral photos, even a mirror, etc.)

Key here is to show your patient and talk about what is going on in their mouth before you begin your treatment- your hygiene service.

Now, you can share that you have a new insurance code and your office will bill for this service. Your office will do their very best to get reimbursement for the patients service today.

Let your patients know that insurance is a benefit, just like their vacation pay and 401k are benefits however, these benefits don’t cover 100% of the vacation or pay for their retirement when they do draw from their 401k one day in the future. No, dental insurance is another benefit and will pay only a certain amount. Tell your patients that you are doing your very best to take pictures and write copious notes to share with their insurance company so they will receive as much reimbursement as possible.

AND…. This appointment to treat the gingivitis is a great opportunity to show your patient how much you care because as dental professionals we are in the business of helping our patients live a healthier and longer life.

At today’s appointment to treat that gingivitis, you can now take extra time to share the good  news that with routine hygiene appointments and by returning in the next 1-4 weeks for a routine prophylaxis appointment, they have a much better chance to live a longer and healthier life.

Patients have no idea how good a clinician you are but they do know how you made them feel!

When you take the time to make your patients feel like they are very important and that you want to help them look and feel better, these patients will be your raving fans. These are the patients who continue returning to your office indefinitely. These are your patients who tell all their friends and family members how great you are!

Are you as excited about the new CDT Code as I am?

Please comment below and also be sure to subscribe to our YOUTUBE Channel when you watch the video message about the new CDT Code:

CLICK HERE TO WATCH THE CDT CODE VIDEO MESSAGE