All about CDT D4341 Dental Procedure Code Billing Questions

CDT D4341 Dental Procedure Code 

D4341 periodontal scaling and root planing four or more teeth per quadrant are therapeutic, not a prophylactic procedure that involves instrumentation of the crown and root surfaces to remove plaque and calculus or other microorganisms from these surfaces. 

It is applicable for patients in earlier stages of periodontal disease with bone loss or subsequent loss, or it could be a further progression leading to a presurgical phase. Root planing removes cementum and dentin that is rough and imbued by calculus or contaminated by toxins that cause soft-tissue removal. 

Restrictions and Requirements from carriers 

• Many insurance companies have minimum tooth eligibility for full quadrant benefits, for instance, 3/5 of a quadrant for three teeth and 4/5 of a quadrant for four teeth. 
• Many insurers want to have written the American Academy of Periodontology case on the claim form. 
• Detailed and probing depths, recession, bleeding, furcations, and mobility help insurers verify the current disease condition. Charting of probing depths reveals the existing and ongoing periodontal disease and process. 
• Probing depths specify details like loss of attachment as the insurers will not pay a benefit for teeth with pocket depths less than 5mm. 
• Payment for D4341 happens once every two years, and for some carriers, it is once every 36 months. 
• D4341 is considered the first rather than the second or final scaling treatment. 
• Annual maximum gets absorbed (PPO). 

Payment limitations 

It is a 24-month period of retreatment, subject to each patient's contract. For specific circumstances, retreatment earlier than one per 24-month period gets approved. If the request for special consideration gets denied, the provider cannot charge a root planing and scaling fee. 

To expedite the claim submission process for three or more quadrants of D4341 scaling and root planing treatment, submit the current dated and preoperative x-rays with diagnostic quality. The documents support the treatment. Also, attach periodontal charting, a copy of the patient's treatment record for rendered service, inclusive of the time taken to treat the three or four quadrants. 

For emergencies, where the treatment gets completed in one visit is documented in the record. Failure to documentation leads to unbillable for the rendered service. 

Difference between D4341 and D4342 and Benefits 

The only difference between these codes is four or more teeth per quadrant or one to three teeth per quadrant. D4342 set your fee at 75% of the quadrant, while D4341 set your practice fee at 40-50%.

The use of D4342 instead of D4341 gives you the opportunity as you will be using the same supplies, the same amount of gauze, a similar anesthetic, the same number of cassettes, and some treatments that do not change from one procedure to another. 

Talk openly with your team before setting fees for periodontal therapy. Having everyone on the same page and relatable to your treatment philosophy helps the RCM and reduces the patient's risk of cardiovascular diseases. Treating periodontal infection actively with these two codes is worth your treatment fee, which can save the medical cost for your patients by $3000 per year.