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CDT-2021 D4346

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.

© 2020 American Dental Association.

warning

D4346 does not define or report a “difficult prophy.”  A "difficult prophy" is D1110 taking a longer period of time. D4346 does not relate to the amount of time or effort required to complete the procedure.  The D4346 procedure is applicable when it is used to treat generalized moderate or severe gingival inflammation in the absence of attachment loss.  In other words, the procedure is based on the documented diagnosis rather than the intensity of treatment or the time required to complete the procedure.

caution

D1110 is applicable for patients with chronic or acute, mild or localized gingivitis, to prevent further progression of the disease, not as a treatment for periodontal conditions.

D4355 enables a subsequent comprehensive oral evaluation (i.e., D4355 is performed upfront prior to the subsequent comprehensive oral evaluation appointment).  D4355 is provided to remove gross deposits from the tooth surfaces that interfere with the ability of the dentist to perform a comprehensive oral evaluation.  The descriptor of D4355 prohibits a D0150, D0160, or D0180 on the same service date.  See D4355.

match

D4346 is a therapeutic service performed after a comprehensive oral evaluation (typically on the same day) has been completed and a diagnosis of generalized moderate or severe gingivitis is made.  D4346 is provided to remove all deposits and allows the tissue time to heal following the diagnosis of generalized moderate or severe gingival inflammation without attachment loss.  Typically a prophylaxis (D1110) would follow D4346 at an interval set by the dentist (2-4 weeks). 

Comments

 

    1. There has been an ongoing debate about how to code for those situations where the treatment is considered more than a prophylaxis, but not rise to the level of scaling and root planing (slight bone loss).  When a patient presents with generalized moderate or severe gingival inflammation, but no bone loss, the time and effort needed to treat the condition is typically beyond the standard prophylaxis.  The inflammatory condition can be chronic or acute, but it is important to note there are very specific diagnostic criterion for submission (generalized moderate or severe gingival inflammation [gingivitis]).  The descriptor clearly indicates that this code should not be submitted with D1110, D4341, D4342, or D4355.  In nearly every case, with appropriate treatment and improved hygiene, moderate or severe gingival inflammation is a reversible condition, so the subsequent maintenance visit (a few weeks later) would be reported using the conventional D1110.  D1110 would follow D4346 at an interval deemed appropriate by the dentist. Note: The existence of a code does not obligate the payer to necessarily reimburse it.

    The delivery of D4346 would only follow a diagnosis of generalized moderate or severe inflammation.  Those definitionsare generally accepted to be:

    A.   The American Academy of Periodontology (AAP) defines generalized chronic periodontitis to be when 30% or more of the patient’s teeth at one or more sites are involved, and it is reasonable to extend this definition to a patient with gingivitis.

    B.   The Gingival Index of Löe and Silness defines gingival inflammation as follows:

    0 = normal inflammation

    1 = mild inflammation- slight change in color and slight edema but no bleeding on                 probing

    2 = moderate inflammation- redness, edema, glazing, and bleeding on probing

    3 = severe inflammation- marked redness and edema, ulceration with tendency to               spontaneous bleeding

    C.  This D4346 procedure is generally expected to be completed on a single date of service, but patient comfort and acceptance may require delivery over more than one visit. Should more than one visit be required, the date of completion is the date of service.

    2.  For additional details regarding reporting D4346, visit www.practicebooster.com/dentalcoding_2019. Use the password published on page 4 of this Guide. 

Limitations

 

    D4346 is a fairly new code, and as with all new codes, reimbursement is not guaranteed, especially in the early reporting of this new code.  D4346 is generally followed by D1110, prophylaxis, after a short interval of several weeks.  There is no set waiting period between D4346 and D1110.  D4346 is a therapeutic procedure to bring the patient’s periodontium back to a healthy status.  Based on the patient’s needs, the dentist is in the best position to determine when the patient can assume a regular preventive regimen following the performance of D4346 that includes an oral prophylaxis (D1110) subsequent to D4346.

Narratives

 

    Narratives and supportive documentation should include:

    a.  Periodontal charting that records (pseudo) pocket depths and bleeding on probing. (Note: pocket depth may be recorded without loss of attachment.)

    b.  Photographs are helpful to document the gingiva’s condition (e.g., visualize localized vs. generalized inflammation) for retention in the patient’s chart.

    c.  Radiographs are helpful to document no attachment loss.  

    d.  A clinical evaluation is made with a diagnosis of generalized moderate or severe inflammation.

Flowcharts

 

Note: Interpretation and utilization of this code and flow chart is based on the ADA’s Guide to Reporting D4346.  This Guide may be found at http://www.ada.org/en/publications/cdt/coding-guidance. Copyright © American Dental Association.  All rights reserved.

 

D6980

REVISED CODE

Fixed Partial Denture Repair

A single cast metal crown restoration that is retained, supported and stablized by an abutment on an implant; may be screw retained or cemented.

NOTE: May be orthodontic related