Why was a new “scaling” code added to the CDT Code?
Dental insurance claims are frequently submitted for D4341/D4342 because the treatment performed is clearly above and beyond a preventative D1110 prophylaxis procedure. However, these claims are frequently denied because insurance companies follow strict guidelines and require documentation proving that there is bone loss or loss of attachment.
Previously there was no CDT code to accurately report treatment for patients with gingivitis/ pseudopockets but no loss of attachment. Simply performing a prophy for these patients would not be appropriate and there aren’t any roots to plane, so scaling and root planing is also not appropriate. This is why there was a need for the Code Maintenance Committee (CMC) to create CDT code D4346.
D4346 should be used when….
- An exam has already been performed;
- Patient is diagnosed with Generalized Moderate Gingivitis or Generalized Severe Gingivitis;
- Generalized pocket depths 4mm or greater are present;
- Moderate to severe bleeding on probing is present; AND
- Radiographs show that there is no bone loss.
Do NOT use this code in any of these scenarios:
- Patient is diagnosed with any classification of periodontitis (vs. gingivitis);
- Patient is diagnosed with Localized Gingivitis (vs. generalized);
- Patient is diagnosed with Slight Gingivitis (vs. moderate or severe);
- Bleeding on probing is localized (vs. generalized);
- Attachment loss is present;
- Radiographs show bone loss;
- There is too much plaque and calculus for an exam to be done.
What to include with the insurance claim:
- Complete periodontal charting, showing pocket depths;
- Narrative (or copy of patient notes) stating the diagnosis, describing bleeding on probing status if not included on perio chart; When last prophy was done, if longer than 12 months and other contributing factors such as plaque deposits, calculus deposits, description of gingiva appearance, pain, malodor, etc..
- Intraoral photographs if they help illustrate the gingival condition