D4346 Dental Code: Scaling for Severe Gingival Inflammation Explained

Back in the year 2017, the American Dental Association’s Code Maintenance Committee approved the dental code D4346, which describes scaling in the presence of generalized moderate or severe gingival inflammation. It stands for full mouth after oral evaluation.

Before this code was introduced, dentists would either use D1110 or D01120 – prophylaxis – adult/child or D4341 or D4342 – periodontal scaling and root planing. Both of these options didn’t fully describe the therapeutic purpose of scaling in the presence of gingival inflammation, for which they had to vote in favor of the D4346 dental code.

D1110 and D4341/D4342

In the dental world, the D1110 code was used for patients who had good oral health or those with localized areas of gingivitis. While D4341/D4342 indicates periodontal therapy for the treatment of active periodontal disease, including loss of bone and attachment.

What is Dental Code D4346?

D4346 Dental Code is used for patients requiring a scaling procedure with a generalized moderate or severe gingival inflammation. Gingival inflammation or gingivitis is an oral ailment involving swelling or redness of gums due to bacterial buildup. Scaling refers to a treatment done to remove plaque, tartar, and bacteria from the teeth’ surface and below the gum line.

According to the American Dental Association, the full entry of dental code D4346 published in the CDT manual is as follows:

“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 planing, or debridement procedures.”

Why Was CDT D4346 Necessary?

Dental Code D4346 was created and included in the ADA’s dental code set to fill the gap. It serves dentists immensely in a situation where a patient has more than localized gingivitis but no bone loss. By using this relatively new code, when the patient doesn’t suffer from bone loss, dental specialists can avoid under-coding and over-coding by using D1110/01120 or D4341/D4342.

The ADA has created a decision tree which acts as a guide for dentists and their support staff in deciding when to use and when not to use dental code D4346. It is important to note that D4346 doesn’t come with frequency limits. 

According to ADA, this CDT code is used for patients suffering from swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing (BOP). Also, the dentist must establish when the patient requires this therapeutic procedure and when they can return to preventive prophylaxis.

Properties of CDT Code D4346

Following are the properties of D4346 that all dental professionals, support staff and dental practices must know.

• It is a therapeutic service code and doesn’t serve as a preventive measure.
• It stands for full mouth procedure and cannot be billed for specific areas of quadrants.
• To code D4346, it is important to establish that at least 30% of the patients’ mouth is affected from moderate to severe gingivitis.
• This code doesn’t include any limit, i.e., child or adult.
• Dentists cannot use this code together with prophylaxis (D1110) or Scaling and Root Planing (D4341/D4342).
• The usage of D4346 requires assessment and instead of the treatment intensity. So, even when the treatment is time-consuming and complicated, the reporting will be done using dental code D4346.
• Documentation requires a periodontal chart to show the presence of gingivitis and the absence of periodontal disease.
• The dental service provider must provide X-rays and radiographic images of the mouth’s inside. These X-rays and images must be submitted to the insurance company with a claim to extract reimbursement against services.
• To determine the healing process and progress of the patient, dentists must set a follow-up appointment around 2-3 weeks after the main procedure date.

For further visits to the dentist, the dentist may use the dental code D1110 if the patient is in a healthy state, D4341/D4342 in case they suffer from bone/attachment loss later and D4346 again if required.

When to Use Dental Code D4346?

The dental specialist will use D4346 when a patient is diagnosed with generalized moderate to severe gingival inflammation but doesn’t suffer from periodontal disease.

Simply put, when the patient has swollen and tender gums, however, they aren’t affected by bone loss or deep pockets in the area around the teeth.

Upon probing, the patient suffers from bleeding inside the mouth in over 30% of the area or has a gingival index (GI) score of 2 or higher.

The patient suffers from periodontal pockets also described as spaces between teeth and gums. If these pockets extend to 4-5 mm in depth and the patient exhibits bleeding or pus.

Other signs that indicate the perfect usage of the D4346 dental code in the claim are when the dentist notices bleeding and swollen gums, bad breath, and loose teeth.

Another situation where using CDT D4346 is deemed correct when the patient has a history of gum disease or if they smoke.

When Not to Use Dental Code D4346?

There are situations when dentists should not use the D4346 dental code. This is because dental professionals and their staff often get confused between D1110, D4341/D4342 and D4346. 

When such a situation arises where the coder isn’t sure about which code is appropriate, they either under-code or over-code it. This is the exact reason why we’re telling you when not to use dental code D4346.

It is crucial to understand why ADA approved CDT D4346. It was introduced because there was a gap in the code set until the code under discussion was released. So, the inclusion of D4346 in the dental code set was done to fill the gap between related codes, i.e., D1110 and D4341/D4342.  

To treat localized mild gingivitis and improve the patient’s general dental hygiene by cleaning deposits, the correct code to use is D1110, as it is a preventive dental code.

On the other hand, when it comes to scaling and root planning because of gingival inflammation involving bone or attachment loss, the dentists are recommended to go for D4341/D4342 referring to periodontitis.

However, when a patient visiting for a dental checkup is diagnosed with moderate or severe gingival inflammation without bone or attachment loss, the most appropriate code suggested by ADA is D4346. This code wasn’t introduced until 2017 and released just to cater to this specific dental concern. 

The D4346 code not only fills the gap between related codes but also draws a fine line clarifying the confusion for dental practices and even insurers.

So, to stay on the right side of regulations, comply with HIPAA rules, and get precise reimbursement against dental services delivered, it is essential to know the intricacies involved and the differences between these codes. 

Not only will it help you avoid the misuse of this code and related ones, but it will also enable you to extract full payment on time.

Benefits of Using CDT D4346 – Gingival Inflammation – For Dental Practitioners

Following are some of the benefits of providing services medically classified using D4346.

Accuracy

Coding and reporting D4346 brings in the accuracy factor. It helps the dentists assess the severity of the gingival inflammation. They can devise a proper treatment plan based on this diagnosis. Reporting this code means the procedure is documented precisely and the patient’s dental records comply with the regulations.

This careful documentation not only helps dental specialists claim the right reimbursement from the insurer but also helps in tracking the progress of the patient getting treatment for periodontal disease.

Detection of Gum Disease Before Time

Using the dental code D4346 helps dental professionals in early detection of gingivitis and starting a treatment procedure to ensure the situation doesn’t worsen with time.

Enhanced Revenue Collection

Treating patients for this disease helps dentists extract more revenue from insurance companies.

Better Health for Patients

From patients’ point of view, getting treated for gingivitis inflammation means better health, healthy gums, fresh breath and reduced risk of bone loss.

Documentation Required for D4346 Dental Code

When reporting dental code D4346: Scaling in presence of generalized moderate or severe gingival inflammation, it is essential that you’re equipped with the exact documentation to ensure compliance with regulations and complete payment collection from the payor. 

Here’s some useful information regarding necessary documentation when diagnosing D4346.

• Thorough documentation of oral evaluation to diagnose moderate or severe gingival inflammation.
• The dentist must ensure credible periodontal charting, having a complete record of bleeding on probing (BOP) and information related to pocket depth between the teeth.
• X-rays and radiographic images to show to the insurer that the diagnosis found no bone or attachment loss.
• Record that shows the treatment would be related to gingivitis and not periodontitis.
• Intraoral photographic evidence to show gingivitis condition affecting the patient, i.e., mild, moderate, severe or localized/generalized.

Do Insurance Policies Cover D4346?

Yes, most dental insurance companies do cover diagnosis and treatment classified by D4346. However, to ensure everything goes according to the plan, you can consult the payor or run a quick eligibility verification before the treatment process.

It helps you steer clear of confusions and inconveniences. Moreover, it is crucial to ensure that the insurance covers fully for this treatment or not, as this code is relatively new.

Final Say

Dental billing is not easy. It is better to understand the nuances and intricacies involved to ensure that your practice remains financially stable. One relatively new code that may cause confusions for dentists, their support staff and even trained coders is gingival inflammation code D4346.

It is used to cure moderate to severe gingivitis to prevent bone loss resulting in periodontal disease. The uncertainty and perplexity caused in the usage of this code and related ones may cause trouble. 

To cater to such a tricky situation, you need to partner with a seasoned dental billing company like Dental Revenue Group that can tackle all troublesome billing and ensure flawless claim submission, resulting in timely and complete reimbursement.

Our highly experienced dental billing and coding experts and denial management professionals will leave no stone unturned in removing uncertainties from your RCM and ensure that all your dental claims are approved on the first attempt.