In the world of dental billing, one overlooked code can make a difference, not only in patient care but also in practice profitability. One such code, D4346, could be a significant missed revenue opportunity if not properly recognized and utilized.
As your billing expert and Director of Billing, I’m here to shed light on how D4346 can be a valuable addition to your coding repertoire, ensuring your patients receive the right care and your practice receives the compensation it deserves.
The ADA introduced the D4346 code in 2017 for a very specific, yet common scenario: patients presenting with generalized moderate to severe gingival inflammation but without bone loss (periodontitis). Previously, there was a gap in accurately coding for these patients who fell between preventive cleanings (D1110) and periodontal scaling and root planing (D4341/D4342).
D4346 fills this gap, allowing dental professionals to provide the necessary treatment without mislabeling patients’ conditions or misrepresenting the service provided.
When hygienists encounter patients with inflamed, bleeding gums without the pocket depths that signify periodontitis, they often provide a more involved cleaning. But without the use of CDT code D4346, they may end up billing for a routine prophylaxis (D1110) or skipping the additional treatment code altogether.
This oversight not only diminishes reimbursement potential but can also prevent patients from receiving the care they need to address gingival inflammation early.
There are several reasons why CDT code D4346 might be underutilized:
Lack of Familiarity: Even though D4346 has been available for several years, some hygienists and billing teams may still be unfamiliar with it. Many are accustomed to using D1110 or D4910 (periodontal maintenance) and might not realize that D4346 is the correct code for cases of moderate to severe inflammation without bone loss.
Complexity in Diagnosis: Recognizing the exact point at which a patient’s condition moves from preventive to needing this scaling procedure can be nuanced. Hygienists may sometimes default to D1110 out of caution or habit.
Insurance Misconceptions: There’s a common misconception that D4346 is rarely covered or is likely to be denied. However, many insurance providers now cover D4346, often with better reimbursement than routine prophylaxis. By failing to bill it, practices miss out on these higher reimbursements and compromise the accuracy of their records.
Every time D4346 is not billed for a qualifying patient, the practice could be losing anywhere from $150 to $200 or more, depending on the insurance company and the reimbursement rate for the area. Over time, these small amounts add up significantly. Missing D4346 in just 10 patients per month could lead to a yearly loss of thousands of dollars. Moreover, accurately coding D4346 helps demonstrate the practice’s commitment to comprehensive patient care, which can lead to better patient retention and satisfaction.
How to Maximize D4346 Utilization…
Educate Your Hygienists and Team: Hold training sessions to review when and why to use D4346. Make sure your hygienists understand the criteria: generalized moderate to severe inflammation without periodontitis. They should know to identify symptoms like gingival bleeding, redness, and swelling.
Document Thoroughly: Clear documentation is essential. Ensure the hygienist notes specific clinical findings such as bleeding, inflammation, and the absence of periodontal pockets. This documentation not only supports the billing but also serves as a record should an insurance company request additional information.
Check Insurance Coverage Regularly: While many insurance companies now cover D4346, policies change frequently. Verify the benefits for D4346 during the verification process so that you can inform the patient of potential costs upfront. By providing patients with transparency, they’re more likely to appreciate the extra effort being made to address their oral health needs fully.
Update Practice Management Software: Review how D4346 is categorized in your billing software and ensure that it is set up for easy access and clear differentiation from other codes like D1110 and D4341. Having the code readily available with prompts or reminders in your software can help your team remember to use it when appropriate.
Communicate the Value to Patients
It’s crucial to explain to patients why they need the CDT code D4346 procedure rather than a standard cleaning. Patients should understand that the presence of gingival inflammation without bone loss requires different attention, and this specialized cleaning can help prevent the progression to more serious periodontal disease. Many patients appreciate when practices are proactive in addressing their oral health issues, and understanding the value of D4346 can make them more receptive to any out-of-pocket costs associated.
Common Questions and How to Address Them
“Why can’t I just have a regular cleaning?”
Explain that routine cleanings are intended for healthy gums, and in cases where inflammation is present, a more extensive cleaning is necessary to remove the bacterial deposits and improve gum health.
“Will my insurance cover this?”
Let patients know that many insurances now cover the procedure, and checking individual coverage is part of your process. This reassures patients that they won’t face unexpected costs.
“Is this a one-time procedure?”
Inform patients that D4346 is typically a one-time treatment to address inflammation. After the initial D4346, the patient will usually return to routine cleanings unless further periodontal treatment becomes necessary.
Final Thoughts on Leveraging D4346 in Your Practice
CDT code D4346 is more than just a code—it’s a tool that enhances patient care and ensures accurate billing. Proper utilization benefits both the patient and the practice, allowing you to address gingival inflammation effectively while optimizing revenue. Many insurance companies recognize the value of this procedure and provide good reimbursement, so there’s no reason for D4346 to go unused.
Taking the time to train your team, update your billing protocols, and educate your patients on the importance of procedures like D4346 is a worthwhile investment. With these steps, your practice will be well-equipped to capture missed revenue opportunities and deliver the comprehensive care every patient deserves.