Dental Hygiene Code D4346 Explained
Dental hygiene code D4346 is defined by the American Dental Association as “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. [It] should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.”
Is This a New Code?
This code was first introduced in 2017. And allows for the treatment of gingivitis. There are some considerations to remember with this code. But that is true of all dental codes.
However, prior to 2017, there was no code available to the dental professional for this level of care. Confusion often was the result. And I have seen dental offices struggle with proper coding for the treatment of gingivitis. Some dentists want to use a debridement code or maybe even prophy 1 and prophy 2.
Neither of these procedures truly fit the treatment. Procedure code D4346 changed this for us in dentistry.
Dental Hygiene Code D4346 Follows an Exam
Dental hygiene code D4346 requires an exam. This differs from the full-mouth debridement code. In addition to the exam, a full periodontal chart is also necessary. And the clinician will also want photographs that show the evidence of gingivitis. The photographs are great tools for patient education as well. Then, be sure to attach all of this documentation to the insurance claim.
There is full-mouth gingival inflammation present. At least 30% of the teeth must display gingival inflammation (moderate to severe). And there is no evidence of periodontal involvement. There is no bone loss nor loss of attachment. And pockets measure less than 4 mm throughout the mouth. Otherwise, a periodontal condition is the diagnosis.
Gingivitis and periodontal disease are not one and the same. Gingivitis is inflammation or swelling of the gums. Periodontal disease is an infection in the gums. However, we know gingivitis can progress to periodontal disease.
No Age Limits
Dental hygiene code D4346 has no age restrictions. And is a code the dental office may use for children and adults alike. This may be a code one would want to use for an orthodontic patient.
Or perhaps a child who has never had a professional dental cleaning. And can also be the right code for an adult who is a little behind on their dental hygiene appointments as well.
There can be no other prophylaxis or periodontal billing that same day, either. And that also includes the debridement code. The dental office can bill for an exam. And in fact, must include an exam to establish the need for a gingivitis diagnosis.
A follow-up exam should be the next step. Most likely, in the next 10 – 14 days. And then a prophylaxis may be the next scheduled appointment.
Dental Hygiene Code D4346 With Patient Explanation
We want our patients to understand what gingivitis is. And to let them know that there is always a risk that this condition can progress to a more permanent periodontal condition.
However, at this point, they are somewhere in the middle. And with proper care, can reverse this progression. We do well to take the time to fully explain where we find ourselves and what we can do together for the best outcome.
Script it! Spend time together as a team discussing gingivitis. Make sure everyone is using the same terminology. And that each team member communicates this specific level of care with ease and consistency.
Our words really make a difference. And when we function as a team with consistent explanations, there are fewer surprises and misunderstandings.
What to Charge?
Dental hygiene code D4346 is a procedure code that falls between the routine prophylaxis and periodontal disease. Therefore, it makes sense that the fee for this code land in between.
My suggestion is to take the middle road. Take your prophy fee and one quadrant of SRP and land in the middle. That is your fee for the procedure to treat gingivitis.
Check on individual insurance plan benefits for this procedure code. As always, benefits vary from plan to plan. We do well not to base our patient care on insurance benefits.
And to consistently work with our patients to help them understand this. As kindly as possible, we guide our patients to receive care beyond their benefits.
And we help our patients embrace a level of care more reflective of their worth. And not their insurance plan’s limited benefit allowances.