What is CDT Code D4355?

D4355 CDT code is suitable for patients with a significant plaque and tartar buildup on their teeth, making it impossible to conduct a thorough oral examination and arrive at a diagnosis. In such cases, the patient’s periodontal charting and probing results cannot be accurate until the debris is removed from the teeth and the area has had time to heal.

Primary intent of the CDT Code D4355

Performing periodontal charting and probing is crucial for making a diagnosis. D4355 should not be used as a preliminary procedure before periodontal therapy, as this is a common coding mistake. This code aims to carry out a full mouth debridement, allowing for a complete oral examination.

In 2018, the CMC (Code Maintenance Committee) updated the code’s nomenclature to ensure that it is emphasized that a thorough examination of the oral cavity and a diagnosis are conducted. It will take place during a subsequent visit. It is essential to review the nomenclature and descriptor of D4355 to understand the definition and intended use of the code.

How could FMD be coded to be paid for services needed and rendered

I am writing to discuss code D4355 and the confusing Explanation of the Benefits (EOB) we received. According to the EOB, full mouth debridement (FMD) is a covered benefit if it is performed alone or in conjunction with other services such as limited oral evaluation, nutritional and tobacco counseling, oral hygiene instructions, radiographic images, adjunctive prediagnostic tests, palliative treatment, or after-hours office visits, and if it is done within 36 months of these services. However, FMD is not covered if any other preventive, diagnostic, or periodontal service has been performed on the same day or within the previous 36 months.

It is not evident because if we perform a D0150 and the doctor recommends FMD, it cannot be done for 36 months. It needs to be clarified how this policy is supposed to be applied in practice and how it affects our billing and reimbursement.

Here is a brief answer for this particular query from PATTI Digangi, founder of DentalCodeology:

The Explanation of Benefits (EOB) can only provide information on what a particular policy covers or excludes. In this particular case, the contract has specific exclusions and limitations. Even though the contract may not appear logical, it is still considered a legally binding document. Challenges and difficulties with third-party reimbursement often arise from misinterpretations of critical terms such as codes and coverage, leading to confusion and complexity.

CDT Codes: These codes ensure consistent, accurate, and uniform documentation of the services for electronic health records and third-party reimbursement.

Coverage:The coverage is a contract between a third-party carrier and primarily an employer of a patient, spouse, or parent. Some dental offices also have contracts with dental benefits carriers. All of these are subject to contract negotiations. The coverage or non-coverage is not based on the discretion of a third-party carrier but rather on the terms of the contract.

The challenge here may be a need for more understanding of the D4355 code redefined in the past couple of years. Most practice management software does not provide the complete definition of the code, which states:

D4355 full mouth debridement enables a comprehensive oral evaluation and diagnosis on a subsequent visit. Definition: Removing plaque and calculus from the entire mouth is a preliminary step in a full mouth debridement that allows the dentist to conduct a complete oral examination. It should not be done on the same day as D0150, D0160, or D0180.