D4346 Dental Code - Gingival Inflammation

Dental care has evolved significantly over the years, not only in terms of technology and treatment options but also in how dental professionals communicate about procedures and bill for their services. One crucial development in this realm is the introduction of dental procedure codes, such as D4346. D4346 is a highly significant code in the sphere of dental billing. Given its novelty, numerous dental practices find themselves unsure about how to effectively incorporate the D4346 code into their pre-existing dental hygiene and periodontal programs. This often leads to accidental confusion with other codes, such as D4341, potentially resulting in reduced reimbursement.
To address this challenge, many dental professionals are turning to the expertise of professional dental billing companies to ensure precise and accurate coding for D4346. Among these, MedsDental Billing Company stands out as a trusted partner, offering a wealth of experience in coding and billing services explicitly tailored for D4346.

D4346 Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation

D4346 name - Scaling in the presence of gingivitis
Dental procedure code D4346, as per the American Dental Association (ADA), refers to a "comprehensive full-mouth scaling procedure performed after a thorough oral evaluation, specifically addressing moderate to severe gum inflammation." The American Dental Association's Code Maintenance Committee approved the code in 2017 to fill the gap between D1110 and D4341 dental code/D4342.
By using this specific code, dental practices can streamline billing processes and ensure proper reimbursement from insurance providers.

D4346 Dental Code Properties

1. Dental code D4346, a valuable procedure, exclusively applies to comprehensive oral care and cannot be billed alongside other prophylaxis or scaling codes on the same date.
2. Dental code D4346 represents a therapeutic service rather than a preventive one.
3. There are no specific D4346 frequency limitations, i.e., it can be done anytime to anyone.
4. This code applies to patients of all ages, including children, particularly in orthodontic care cases.
5. Irrespective of the patient's age, it is imperative to have a comprehensive periodontal chart to demonstrate the absence of any periodontal disease before administering D4346 treatment.
6. For D4346 to be warranted, a minimum of 30% of the patient's mouth must exhibit moderate to severe gingivitis. Importantly, this determination is not based on the presence of calculus but on the extent of gingival inflammation.
7. Incorporating intra-oral photographs into the dental record serves a dual purpose. Firstly, it aids in patient education, offering visual insights into their oral health. Secondly, these images can be utilized when submitting insurance claims to support the necessity of the D4346 procedure.

Why was D4346 added to the CDT Code?

The addition of code D4346 to the Current Dental Terminology (CDT) was a response to a specific clinical need within dentistry. The American Dental Association (ADA) recognized that the existing CDT codes primarily addressed procedures for patients with either generally healthy periodontium or periodontal disease accompanied by attachment loss, such as periodontal pockets and bone loss. Here's a more detailed explanation:

1. CDT codes like D1110 focus on preventive procedures and can be therapeutic in cases where the periodontium is generally healthy and deposits need removal to control irritation factors. They are also applicable for localized gingivitis to prevent its further progression.
2. On the other hand, codes D4341 and D4342 represent therapeutic procedures for patients requiring scaling and root planing due to bone loss and associated attachment loss. Removing deposits from exposed root surfaces is a crucial part of these procedures.
3. However, there was a gap in the CDT codes for patients with generalized moderate to severe gingival inflammation, potentially with pseudo-pockets, but without any evident bone loss. Code D4346 was introduced to address this specific treatment scenario.

Including D4346 in the CDT codes improve the accuracy of documentation and reporting in dental practice. It helps eliminate the need for considering D4999, which requires a narrative containing specific information that may complicate the auto-adjudication process. Additionally, it prevents the misclassification of procedures as prophylaxis (undercoding) or scaling and root planing (overcoding), ensuring that treatments are accurately documented and billed for.

Appropriate fee/price for D4346

Determining the appropriate 4346 dental code price involves careful consideration tailored to each dentist's unique business circumstances.
Considering their unique circumstances, dentists can choose a fee that aligns either with a prophylaxis fee or a scaling and root planing fee. Over time, this fee may be subject to adjustments based on experience and market factors. Moreover, the geographic location also significantly determines the cost, meaning that different regions may ask for different costs.
It is essential to note that dental benefit plans come with limitations and exclusions, which can impact the reimbursement amounts and how frequently D4346 can be performed. These limitations are primarily determined by the patient's benefit plan contract through their employer, and they may vary significantly among different employee benefit plans and insurance providers.

Documentation Requirements for D4346

Proper documentation is essential when using D4346 to ensure accurate billing and support the procedure's necessity. ADA recommends that the presence of crucial things will help in precise claim submission for D4346.

• Full mouth periodontal charting
• Radiographs showing bone levels
• Intraoral photos to document the presence of moderate to severe gingivitis
• Clinical notes demonstrating diagnosis, treatment, etc

Submitting D4346 on insurance claims

As previously discussed, it is mandatory to include a comprehensive full-mouth periodontal chart as an attachment when submitting your claim for D4346 treatment. This procedure is fundamentally rooted in a careful diagnosis, so your claim should incorporate the periodontal diagnosis in a descriptive narrative or on the accompanying periodontal chart. Furthermore, providing detailed information concerning any bleeding on probing is imperative.

D4346 dental code covered by insurance

It is said that insurers cover D4346 like many other codes. Since D4346 is a relatively new procedure code, insurance companies gather actuarial data to make informed decisions about coverage, limitations, and exclusions. This means there can be variations in how different insurance payers handle this procedure.
Understanding that every patient's oral health needs are unique, it is crucial to recognize that not all procedures are automatically covered by insurance providers. Therefore, it is advisable to read the insurance policy contract and pursue predetermination/preauthorization with the insurance company to obtain an estimated understanding of the benefits applicable to the D4346 procedure.

Unlock Revenue Potential with MedsDental Billing: Mastering D4346 Coding Excellence!

MedsDental Billing Company is your trusted partner for all your Remote dental billing needs. With years of experience in the healthcare industry, our team is well-equipped to handle complex coding tasks, including the D4346 code. We take your patients' privacy seriously and are fully HIPAA compliant, ensuring that your dental practice's data remains secure and confidential. Our commitment to staying at the forefront of technology sets us apart. Our state-of-the-art software and tools enable us to streamline the billing process, improving accuracy and efficiency. We take pride in our team of certified coders who are experts in their field, ensuring that your dental procedures are accurately coded, maximizing your reimbursement, and minimizing denials. Choose MedsDental Billing Company and experience the peace of mind of knowing your dental billing is in the hands of seasoned professionals who prioritize compliance, technology, and precision.