You already have a well-honed system developed and perfected over time to manage your hygiene department. Maybe not perfect, there are more holes over the past few years but at least CDT coding has been stable. In 2017 a new code for gingivitis care has the potential to shake up this stability. The code provides a way to consistently communicate the importance of treatment of early disease and oral-systemic connections and gives our patients reasons to return to the practice.
Inflammation is the Key
In most practices, the office manager leads the way with coding and so much more. Yet office managers are not generally concerned with the percentage of patients with inflammation. This will change because inflammation is one of the most significant portions of this new code that reads: D4346 scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation.*
Generalized moderate or severe inflammation are not underlined and italicized in CDT 2017. They are emphasized here as the key to the diagnosis of gingival disease and use of this new code.
Look at Potential
Office managers understand numbers so let’s look at the potential. Studies from the Centers for Disease Control and Prevention estimate that 64.7 million American adults have moderate or severe bone loss periodontitis. The remaining 50+% are being treated under D1110/D1120 prophylaxis codes. How many of your patients can you accurately state have moderate to severe inflammation? That answer is not evident because inflammation has not traditionally been documented. You were basically flying blind when comes to managing this disease across your entire patient base.
We know many children have gingival disease. Biofilm pathogenicity is not limited by bone loss and also not limited by age. How many children have moderate to severe inflammation? The answer is even less evident because any type of documentation of periodontal conditions for children has not been our tradition. This new code does not have age limitations and is applicable for the treatment of children. This may totally change our definition of who is at risk for periodontal disease and who we should screen.
Ask your dentist and hygienists how many truly healthy patients they see. The number is low. Most patients present with some level of active disease; the horse has already left the barn so to speak. Using preventive procedures intended to prevent or reduce the likelihood of disease does not make sense when disease is already present. This new code (D4346) provides the opportunity to identify this disease process and treat it therapeutically.
Minimum Documentation Required
The minimum documentation needed for this new code includes:
- Periodontal charting that records:
- Pseudo pocket depths
- Bleeding on probing (BOP)
- Inflammation index
- Radiographic images
Though not required, full mouth intra-oral photos assist in decision support and documentation for the patient, the clinicians, and the insurance carrier.
This documentation should be the same for children. The evaluation codes are not age-based. (Note: The exception is D0145 oral evaluation for a patient under three years of age and counseling with primary caregiver.) Whether a D0150 or D0120 evaluation is performed, a diagnosis and treatment plan is required as per the CDT section definition for Clinical Oral Evaluations.
As already noted, this new code does not have age limitations and is applicable for the treatment of children. In a new book, DentalCodeology: A Gingivitis Code Finally! (DentalCodeology.com) several cases are presented to help understand using this new code. Two 6-year-olds are discussed. One child has <30% inflammation and does not qualify under the new code. The second 6-year-old has >30% inflammation and does qualify under D4346. The only way to determine the percentage of inflammation is through documentation and, as suggested, photographic support.
Communicating the Difference to Patients
Treating gingivitis disease may help prevent or at least reduce the risks of death from oral cancers, pre-term births, strokes and heart attacks, diabetes and Alzheimer’s disease to name just a few. This provide tangible reasons to return. This new code will give us new opportunities to elevate the standard of care whiles boosting our bottom lines.