Right now, we can utilize regular prophies as a preventive procedure and codes 4341 and 4342 for more therapeutic procedures. A new code (D4346) potentially can close that gap and allow clinicians to report a therapeutic treatment of patients with generalized, moderate to severe gingival inflammation but without exhibiting pockets and bone loss. A “Difficult Prophy” code if you will.
Code D4346: Scaling in the presence of generalized moderate or severe gingival inflammation/full-mouth after oral evaluation. The exact description is the removal of plaque, calculus and stains from the supra and subgingival 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 supra bony pockets and moderate to severe bleeding on probing should not be reported in conjunction with prophylaxis, scaling and root planing or debridement procedures.
It sounds like the code will be effective January 1, 2017. Suggested fee: $230 Metro/$190 Outstate.
It is possible this code could close a CDT gap that presently exists. Stay tuned to see what insurance reimbursements are.