One of eleven new CDT codes coming to life in January, 2017 is D4346 scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation. This code will be included in the SoftDent Annual CDT Code Update, which will be shipping to our clients later in 2016. So why am I writing about this one new code from the group of eleven? Well, this particular code appears to be very confusing in its usage. In fact, D4346 promises to be so challenging to dentists that the ADA has written a 10 page guide to using it! Seems like this new code should be handled with care. I will attach a link to the ADA guide at the end of this post for your reference.
It will be interesting to see how insurance carriers will handle D4346. Will it be covered? It's too early to tell, but some quick research indicates that carriers will be all over the board on this. Some will reimburse it as a standard prophy (D1110), others may cover it based on a relative value of 1.5 - 2x a prophy, still others will exclude it completely. Lots more to come as we close in on 2017.
D4346 will be available for use on January 1, 2017.
A Guide to Reporting D4346
So far on the new 4346 code, Delta Dental will only pay as a 1110 and you have to write off the rest of the new fee. I was told at a coding class that if you are going to use this code, make sure you take a intraoral picture before you start and after you finish and send them in with the claim along with a description of how long it has been since last cleaning and description of gun health. In the new day of electronic claims, you may have to use this as an appeal. I have not had any luck with this code yet. however, if we all appeal it everytime, it will eventually get paid down the road. A few claims i amended the claim to a 4355 and then it was paid so we didn't have the huge write off.