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Troubleshooter: Is office using CDT code 4346 correctly?

May 6, 2021
It's always important to code correctly for procedures, but sometimes things aren't always perfectly clear. Here is clarification for a commonly used code.

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QUESTION: I have a young patient who has not had a prophylaxis in six years and has bad hygiene. After full mouth x-rays and diagnosis from the doctor, the boy has localized early periodontitis and generalized gingivitis. Can we code this as a procedure 4346 scale and root debridement one to three teeth in each quadrant and accomplish this in one day?

ANSWER FROM KATHY S. FORBES, BS, RDH, Professional Dental Seminars Inc:
You ask an interesting and common question. It is so good that you have an actual diagnosis before you determine what procedure would be appropriate for this patient.

According to the descriptor for D4346, there must be "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. It should not be reported in conjunction with prophylaxis, scaling and root planning, or debridement procedures." So, to answer your question, the procedure of D4346 would not be indicated for this patient.

It would appear that from the information you provided, the D4342 may be appropriate for each quadrant if there are periodontal pockets with clinical attachment/bone loss. It would depend upon severity of bleeding, amounts of calculus, and more. Remember, in order to provide scaling and root planing procedures, you must be instrumenting on roots.

Good luck, and I hope this helps!

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