Oregon want to know about D4346

A participant in my Oregon course asked:

Are there any time limitations to using an SRP code after the Gingivitis Code? I had heard 2 years?

Can the D0171 re-evaluation code be used if it is done by the dental hygienist or does the dentist have to be involved or use that code?

In your experience are people charging more than a prophy on the gingivitis code? And how can value be built in that appointment perceived by the patient to charge a different code since it won’t seem different than a prophy to them?

Patti responded: 

Let me take your questions one by one:

Are there any time limitations to using an SRP code after the Gingivitis Code? I had heard 2 years? From a coding perspective, there are no limitations. Codes have few limitations. An example might be for ‘by report’ codes. The codes with that language require a narrative. As I talked about during the course, every carrier and every policy is different. I can no more say that ‘x’ company has limitations than I can say what someone car insurance covers. Too much variety and based on what was purchased.

Can the D0171 re-evaluation code be used if it is done by the dental hygienist or does the dentist have to be involved or use that code? This is a little trickier to answer from a codes perspective particularly for Oregon. Oregon and Colorado are the only 2 states that currently and RDH can perform a diagnosis. Your state practice act and rules clarify what can and can’t be done under your license. If I am looking form a narrow focus of the codes, there is general section in the Evaluation codes. D0171 is in that section. In the general description, there is language that says some part of the dental exam can be delegated, the evaluation which includes a diagnosis and treatment plan is the responsibility of the dentist. Does that mean an RDH can’t use that code. I have many friends in CO that had it clarified by their Board of Dentistry as well as by carriers that an RDH in CO can use those codes.

My Insider’s member group part called the DentalCodeology Consortium has brought this issue to the code committee. We believe the language should be changed to remove dentist and add ‘as allowed by each state laws’ or something along that line. We did not win that argument yet. The limiting language remains.

So what does that mean for OR hygienists? You might want to check with your board and carriers. At the same time, you might not want to. Why? It has been my experience that when asked, often the answer is negative. Ask for forgiveness, not permission.

In your experience are people charging more than a prophy on the gingivitis code? And how can value be built in that appointment perceived by the patient to charge a different code since it won’t seem different than a prophy to them? Really important questions and thoughts. And difficult for us to get our heads around. If we have a problem and aren’t clear, we won’t be with our patients. I say D4346 is a game changer because it gives us the opportunity to change our protocols which also changes our communication. We have been providing the treatment under D1110 for years, so what’s the difference? The diagnosis which is the answer to any treatment and coding question. Even though we may have given lip-service to bleeding and inflammation, we didn’t recognize it for the disease process it is and that there are level of infection.

On the other hand, just because there is a new code, you don’t have to charge a higher fee. We are obligated to code properly. The fee is a separate practice management issue. Will charging more build value? That is for your office to decide. Will patients really get the difference? They should with our communication, not what we physically perform. Unfortunately, we as professionals think of our services as commodities: a prophy, a crown, an implant. We don’t seem to value the expertise it takes to make the accurate diagnosis and treatment plan. We communicate this to our patients. We have taught them that dentistry is a commodity, this is one of the many ways we can teach them something else, As I mentioned, I have been around a long time and sometimes I fall into over-explaining. That happens with patients too. The simple phrase is “what we now know is…”

 

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