4346/D4346 Code for Dental Scaling -
How To Successfully Use It

There is a new procedure code that every general dentist office needs to know about. This new CDT code was created by the ADA's Code Maintenance Committee (CMC) to be consistent with the widely accepted "Code for what you do" philosophy. It goes into effect on January 1, 2017.

Prior to this 4346 code, dentists were performing dental treatment that had no code. For reimbursement purposes, they were either overcoding to 4341/4342 Scaling & Root Planing (resulting in many denied claims), or undercoding to 1110 Prophy. Both are inappropriate because they are not codes that accurately describe the service actually rendered.

Example case

Here is an example of one possible scenario for this situation:

So far, so good. But what is the recommended treatment? Most dentists and hygienists intuitively know what he needs...clean him up, and get his oral hygiene back on track. It will most likely take a significantly longer appointment than a regular prophy. More instrumentation will be required. Possibly two appointments. Possibly with local anesthetic. More time spent with oral hygiene instruction. But how do you code for this? Prior to the new D4346 code, the choices were...

Now, the new D4346 code fills this gap. It finally allows the dental office to code for what was actually done.

Another example case for D4346

D4346 details

Submitting D4346 on insurance claims

Insurance coverage of D4346

Implementing the new code

Important periodontal concepts that everyone should know

There is a significant lack of understanding of some key clinical periodontal concepts by dentists, hygienists, insurance companies, dental consultants, and dental advisors. But it is critical to be familiar with these concepts in order to properly utilize the periodontal codes, especially the new D4346 code. If you read through these concepts and find any of them unfamiliar, then try to increase your knowledge until they become second nature. Only then will you be able to understand a proper periodontal disease diagnosis, and the corresponding treatment (and code).

1. Deepening pocket depths have multiple causes:

2. There is a significant difference between Pseudopocket...

... and True Periodontal Pocket:

3. Loss of Attachment features:

4. Clinical Attachment Level (CAL):

5. AAP has definitions we should understand:

6. Periodontal disease isn't a diagnosis:

7. Calculus location is meaningful:

8. Generalized moderate to severe gingival inflammation:

It is important to understand what Scaling and Root Planing is...and isn't

History of the D4346 code

Code comparisons (as of CDT 2017)

Difficult prophy

Implants

ADA's Code Maintenance Committee

Who makes the CDT Codes? The committee has input from numerous stakeholders. As of 2017, the 21-member CMC consists of:

Anyone can request a CDT code addition, revision, or deletion. Every year, requests are submitted from dentists, hygienists, educators, and organizations. If you are interested in suggesting changes to the CDT Code, go to the ADA's "Request a Change to the Code" page for instructions. Every submission is reviewed, and the ADA encourages involvement from all areas of dentistry. Personally, I think it is important for practicing dentists to be a part of this process.

Further reference