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Gingivitis Code: What You Must Do!

By: Debbie Seidel-Bittke, RDH, BS

February 2, 2017

Welcome 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.”

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.