I did not plan to become The Chief Dental Codeologist. Yet over the past 20+ years, I have come to realize that I am a futurist. I have internalized some strong beliefs about oral health.
Dentistry is no longer about fixing teeth; it is oral medicine. I believe we can have a world without cancer and meet the 2020 World Federation of Dentistry goal for a caries-free world.1 What’s more, we can cure not just manage periodontal disease. Big goals like these need measurement each step of the way. Big goals need a grass-roots movement!
What is DentalCodeology?
Dental procedure coding plays a part of every single patient encounter. I coined the word DentalCodeologytm. The Merriman-Webster Dictionary defines ology as: a branch of knowledge; the study of. DentalCodeology means the study of codes. Studying codes provides a deeper understanding with a goal to improve the quality, efficiency, and overall value of health care.
Reimbursements will be tied to patient outcomes in the future. Having a code provides the measurement tool (metric) and the opportunity to measure outcome data.
Power of Metrics
The term metric is somewhat new in healthcare since it can be interpreted in slightly different ways depending on the circumstance. As dentistry changes from a treatment-based to diagnosis-based profession and also evolves from a fee-for-service to a values-based profession, metrics will become more important.
Metrics can give us the power to:
- Quickly arrive at data-driven decisions that can improve outcomes and performance
- Drive cost savings
- Enhance patient quality of care and satisfaction.
Codes provide the metrics for dentistry. Currently we have only Current Dental Terminology (CDT) procedure codes. Dentistry also needs diagnosis codes.
There is no agreement or final decision made on which standardized dental diagnostic terminology will be used. Since 2007, the American Dental Association (ADA) has been developing and updating the Systematized Nomenclature of Dentistry (SNODENT) a vocabulary designed for use with electronic health and dental records. Diagnosis codes will provide further metrics.2
Moving Dental Payment from Volume to Value
Value-based payment models have the potential to upend traditional patient care and business models. Rising costs, aging populations, and the emergence of disruptive technologies are just a few of the challenges facing our healthcare systems including dentistry.
To address these challenges, the dental profession has endorsed an evidence-based approach to clinical practice and oral health care. This system is commonly known as evidence-based dentistry (EBD).3
The goal of EBD is to help practitioners provide the best care for their patients. EBD assists practitioners with integrating the best available evidence with clinical expertise and the needs and preferences of the individual dental patient.
Value-based dentistry helps dentists to deliver individualized treatment options to patients that align with their values and desires. Table 1 shows evolving nature of this transition.4 The metrics of coding gives us the opportunity to measure outcome data in a values-based healthcare system.
D4346 New Gingival Inflammation Code
Inflammation is the body’s attempt at self-protection and to begin the healing process. Current science believes inflammation is the oral-systemic connection.
The Code Maintenance Committee5 appointed by the ADA annually creates, revises and updates CDT procedure codes. The goal of these updates is to embrace new technologies, materials and procedures that can lead to earlier intervention and prevention of oral disease and positively influence systemic health. Each year, the committee has many submissions to consider.
The new CDT 2017 code that has caused great confusion for many professionals is D4346: Scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation.6
We can finally treat gingivitis after decades of merely dumping gingival inflammation into the same category as health. This new code can potentially close the loop and elevate our standard of care. With increasing research pointing to the connection between oral disease and medical conditions, the timing is perfect. Early recognition ensures earlier intervention and disease prevention.7 The ADA created a guide as a resource to educate dentists and others in the dental community on the newly approved scaling code.6 Even with this document, confusion continues.
A Gingivitis Code Finally! is the fifth in the DentalCodeology series. The DentalCodeology series of books are dedicated to helping dentistry provide more efficient, cost-effective, evidence based care. They are designed to help professionals code more accurately increasing practice profitability an improving the oral-systemic health of their patients.
DentalCodeology books are easy-to-read bite-size books for busy people. The books contain easily digestible stories/case histories about patients like those we see every day. (Box 1 shows the books series to date.)
It was not the original plan for the series to have an entire book on one procedure code. Yet, D4346 needs its own book because it is a game-changer. As research continues to show, there are consistent relationships between oral inflammation and systemic diseases.
D4346 can be a game-changer for dentistry because it gives us the opportunity to recognize and treat inflammation. Patients, dental hygienists, dentists, dental specialists and other health care providers need to modify our assessment, prevention, and treatment protocols to improve the oral health as well as the total health of our patients.
The Dental Codeologist Community
We live our lives on the backs of those who have gone before us, and we cannot achieve anything without building upon someone else’s work or without the assistance of others. The latest brand extension of the DentalCodeology book series is The Dental Codeologist Community which was officially rolled out at the RDH Magazine Under One Roof meeting this summer.
The member’s-only approach provides cutting-edge content, forums and other pertinent information and interactive opportunities for share questions, knowledge and stay up-to-date. The DCM (Dental Codeologist Member) keeps the importance of accurate dental coding top of mind in a continuous, interactive way while also providing dividends via CE credits, virtual consultation and some cool deals.
This grass-roots movement is open of anyone interested in having a say and be proactive in the dental procedure coding world. That’s why you can call me the Chief Dental Codeologist.