CDT D4346 Dental Procedure Code
This procedure code is a game-changer and bridges the gap between preventive prophy and scaling, and root planing went into effect on January 1, 2017. This new CDT code accurately described the services rendered, resulting in clean claims and no over-coding or under-coding.
When and How to use the D4346 Dental Code?
As per the American Dental Association (ADA), D4346 Dental Code is scaling in the presence of generalized moderate or severe gingival inflammation- full mouth, after oral evaluation.
The description code reads the removal of plaque and calculus than usual. There have been stains and show many areas of supra-and sub-gingival tooth surfaces like 4mm, 5mm, or even 6mm pockets around teeth that cause severe or moderate gingival inflammation.
Patients with bleeding during probing, swollen or inflamed gingiva, and suprabony pockets don’t go in conjunction with prophylaxis, root planning, scaling, full mouth debridement, and unspecified periodontal procedures.
Points to consider:
- The procedure qualifies as a D4346 when an oral evaluation is complete. The patient evaluation and treatment planning involve generalized- moderate to severe Gingivitis inflammation with no bone loss or no attachment.
- Generalized moderate refers to bleeding on probing, redness, edema, and glazing, whereas severe gingival refers to ulceration, marked redness and edema, and spontaneous bleeding.
- D4346 is a therapeutic service based on the diagnosis of gingivitis to remove all deposits rather than the intensity of the treatment to allow tissue healing.
- D4346 is appropriate after the oral evaluation of periodic (D0120), comprehensive (D0150), or comprehensive periodontal (D0180), irrespective of the delivery and reporting of the date of service.
- There is no waiting period between D4346 and the routine preventive regimen. The dentist determines the delivery of the oral prophylaxis to bring the patient’s periodontium back to health.
- It is a full-mouth procedure and involves completion in a single day. However, as per the patient’s comfort, the treatment may go for more than one visit where the date of completion is the date of service.
- The documentation should include period charting that records with or without pseudo pocket depths and bleeding on probing. Diagnostic and radiography images to understand the gingiva condition like inflammation, loss of attachment, or bone.
- Dental professionals regulating the state laws may deliver the service documented with CDT codes.
Appropriate fee for D4346
- Dental professionals delivering the D4346 procedure set an appropriate fee discreet to each dentist’s business decision between a prophylaxis fee and scaling and root planing fee. However, with experience, the D4346 procedure fee may be adjusted.
- Dental benefit plans have coverage limitations and exclusions that may limit reimbursement amounts and frequency. The patient’s benefit plan contract as per the employer determines benefits. There are chances of variation among employee benefit plans and insurance payers. Since it is a new code, insurance companies collect actuarial data to decide coverage, limitations, and exclusions.
- Every patient’s need is different. However, not all procedures in oral health get covered by the payer. Therefore, predetermination is the safest way for estimated benefits.
