NMDA Journal Spring 2020

20 New Mexico Dental Journal, Spring 2020 Update Summary: ADA Guide to Reporting D4346 Version 4 July 11, 2018 If you don’t want to read the eleven-page ‘Version’ on how to use this code, then read this: D4346: Scaling in presence of generalized moderate or severe gingi- val inflammation—full mouth, after oral evaluation is described as the “removal of plaque, calculus and stains from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis.” It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. Should not be reported in conjunction with prophylaxis, scaling and root planning, or debridement procedures. This scaling code was added to reflect that there was no CDT Code to accommodate the treatment of gingival inflammation with no bone destruction which means no loss of attachment. The procedure is based on a diagnosis and not the time or intensity of the treatment. The oral evaluation and this procedure can be charged on the same day. There is “no set waiting period” when an oral prophylaxis is per- formed because the use of D4346 is designed to create a healthy gin- gival environment. If the procedure takes more than one day, then it is charged out on the completion date. Anesthesia may be required and is noted in the patient record. Periodontal charting noting (pseudo) pocket depths and bleeding of teeth and implants, and photographic and radiographic diagnostic imaging, document the support needed to use the code and the records should be less than a year old. Since there is only a year of claim history using this code, the fee is determined by the dentist most likely using an amount between a D1110 and a D4341 procedure. The frequency limitation and fee reim- bursement are determined by the benefit plan. At some point in the patient’s life, he will probably develop bone loss and the treatment would change precluding the use of this code. The Guide includes illustrations of situations where gross debride- ment may be applicable. To look at these, go to the ADA website and look them up. https://www.ada.org/~/media/ADA/Publications/Files/D4346EducationGuidelines_ V4_2018Jul06.pdf. DecisionTree Gross plaque & calculus inhibits oral evaluation? Generalized moderate-severe gingival inflammation no attachment or bone loss. Evaluation and Treatment Planning D0120 D0150 D0180 Scaling in the presence of... D4346 Prophylaxis D1110 D1120 SRP D4341 D4342 Debridement D4355 OR Yes After adequate healing No OR If present, inflammation is localized. Periodontitis with bone and attachment loss. Copyright © 2018 American Dental Association. All rights reserved. Reprinted with permission.