Do You Know the Insurance Codes for Peri-Implant Mucositis and Peri-Implantitis?
Implant dentistry will only continue to grow with the advancement of minimally invasive technologies like the REPLICATE™ Immediate Tooth Replacement System continuing to improve surgical techniques, patient recover and esthetics. Dental implants in general have a very high success rate, and they can last a lifetime.
However, this does not mean we can take this success for granted, as implant failure can be commonly attributed to peri-implant mucositis and peri-Implantitis.
Prior to 2017, there were gaps in the dental coding system for the professional care clinicians needed to diagnose and treat these conditions and to help patients protect their investments.
Role of Inflammation
Inflammation is the body's attempt at self-protection and to begin the healing process. Current science believes inflammation is the oral-systemic connection. A recent American Academy of Periodontology report (Perio.org) described the difference between peri-implant mucositis and peri-implantitis. Both are characterized by an inflammatory reaction in the tissues surrounding an implant.
Specifically, peri-implant mucositis is the presence of inflammation confined to the soft tissues surrounding a dental implant with no signs of loss of supporting bone. Peri-implantitis on the other hand, is an inflammatory process around an implant, which includes both soft tissue inflammation and progressive loss of supporting bone.
New Inflammation Codes
Annually creating, revising and updating CDT* dental codes to embrace new technologies, materials and procedures that can lead to earlier intervention and prevention of oral disease and positively influence systemic health, has been the goal of the American Dental Association’s Code Maintenance Committee since 2012. Each year, the committee has many submissions to consider.
Two new insurance codes of related and equal important were approved for use starting in 2017. Both fill considerable gaps in the oral health system. They are:
- D4346: Scaling in the presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation
- D6081: Scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surfaces, without flap entry
These New Codes Can be Used Together or Not
The new D4346 code, as its name indicates in the presence of moderate to severe gingival inflammation. The Low and Silness Gingival Inflammation Index has suggested by AAP and the American Dental Association to define moderate to severe as:
- 0 = no inflammation
- 1 = mild inflammation- slight change in color and slight edema but no bleeding on probing
- 2 = moderate inflammation- redness, edema, and glazing, bleeding on probing
- 3 = severe inflammation- marked redness and edema, ulceration with tendency to spontaneous bleeding
It must further be determined that this Level 2 & 3 inflammation is localized (<30%) or generalized (>30%) of the teeth. The code specifically states in its name “full mouth” with a description, saying, “..Should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.”
There is an exception: The other new code D6081 for a single implant exhibiting peri-implant mucositis or peri-implantitis is the only code that can be used in conjunction with the new D4346 code.
Both codes are specifically-related to the inflammation and mucositis that can be damaging to the long-term health of the patient. (to learn more, see DentalCodeology.com)
Codes are not only about dental benefit payment, they are also about treatment metrics. As healthcare in United States moves from fee-for-service to a pay-for-performance model, clinical metrics are becoming more important than ever.
Another new insurance code of consequence to implantologists fills another gap in the previously existing odes. This new code enables more accurate documentation and can be reported as:
- D6085 provisional implant crown: Used when a period of healing is necessary prior to fabrication and placement of a permanent prosthetic.
Early Identification and Early Therapeutic Treatment
Both gingivitis and peri-implant mucositis are serious. Both need attention and therapeutic care. We don’t want to wait for bone to be lost. Even with regeneration therapies, the reason professionals choose the minimally-invasive dental implant is to preserve hard and soft tissues and give amazing esthetic results.
It only makes sense to help patients continue to have those results with early identification and early therapeutic treatment. With these new codes, we also have more ways to measure success.