There are eleven new CDT codes for 2017 (effective on January 1, 2017), and one new code that has attracted a lot of attention is the D4346 – Scaling in the presence of generalized moderate or severe gingival inflammation.
The new CDT code fills in the gap between a regular cleaning on one end and treatment for gum disease on the other. Dental team have struggled with how to code services for patients who need more than a regular cleaning yet scaling and root planing and even a full mouth debridement are not appropriate. Starting in 2017, dental teams can consider the D4346 for these patients.
The code descriptor indicates the D4346 is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. In addition, the code cannot be reported at the same time as a prophy, full mouth debridement, or SRPs (D4341 or D4342). In most cases, patients who receive a D4346 will return to a regular cleaning and six month recalls (assuming home care improves).
Keep in mind that just because a new code is available does not mean insurance companies will pay for the new procedure. However, the odds are good that carriers will start allowing this new code in hopes it will reduce instances where the SRP codes are used incorrectly.
Make sure your dental team is aware of the changes to the CDT codes starting January 1, 2017. And review your hygiene and perio protocols to ensure you provide the appropriate treatment for patients who need more than a cleaning but who do not need perio therapy.