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
Facts/When To Bill:
D4346 is Therapeutic (Not preventive like 1110.)
Not age or dentition base (can be done on children, consider ortho patients diagnosis).
Full mouth procedure (not billed in quadrants like 4341/2).
Available to start billing January, 2017 (It may take a few months for insurance to recognize payment).
Generalized=30% of the mouth must have generalized moderate OR severe gingivitis. Not based on the amount of calculus.
When NOT To Bill:
If you have localized moderate-severe gingivitis the code to use is still D1110.
If you have generalized slight gingivitis use the code D1110.
If periodontitis is present on 1+ teeth use D4241/2.
What Treatment Is Next:
“The dentist is in the best position to determine when the patient can assume a regular preventive regimen that includes oral prophylaxis.” -ADA
Interpretation- Determine with the dentist when the patient should be seen next.
1- Perform the initial D4346 procedure then wait 2-6 weeks for a re-eval and at the re-eval do a D1110 prophy. Then reappoint for the regular maintenance care from 4-6 months.
2- Perform the initial D4346 procedure then reappoint in 4-6 months for the regular maintenance care.
Set up a protocol on what is best for your office and patients with the dentist.
Unknown at this time. Since it is a therapeutic procedure, it may be covered just like the other 4341/2 codes at a percent with a deductible.
We shouldn’t base treatment on insurance coverage. If the patient has generalized moderate-severe gingivitis then this code should be billed.
Evidence of the disease should be documented with full mouth probe depths including bleeding points and the diagnosis. Consider sending intra-oral photos as well. You may have to update your protocol on when to probe children/adolecense. In many office it is at the age of 18 but since this code is not age specific it may be necessary on our younger patients.
Verbiage With The Patient:
We (with your assessment and the dentist's diagnosis) found today that you (or your child) have generalized moderate/severe gingivitis. The good news is that this is reversible. I will give you a few actions at home you need to be doing. I will also need to do a therapy on your gums to get the healing process started today.
NOTE: It would be helpful to show the patient evidence of the disease by taking intra-oral photos and their probe depths with bleeding points.
D1330 Perform oral hygiene education as per the patient's needs.
D4346 Perform the scaling in presence of gingivitis therapy.
D9630 Consider chlorhexidine rinse as needed.
The above information was summarized from the ADA publication below. http://www.ada.org/~/media/ADA/Publications/Files/D4346EducationGuidelines_Final2016May17.pdf?la=en
If you want more information I would recommend the following resource as well.