Thursday Troubleshooter: Misuse of code 4346 means dental practice is committing fraud
This dental team member has moved practices and is surprised to find the new office has little understanding of code 4346. Turns out they're committing fraud.
Nearly everyone has problems and concerns on the job, and sometimes you're just too close to a situation to solve something yourself. Share your concerns with Team Troubleshooter, and the experts will examine the issues and provide guidance. Send questions to email@example.com.
QUESTION:RDH magazine published an article regarding the new code for gingivitis. I have just moved from one state to another, and the dental hygienist in the new office I’m in believes that prophy just covers above gum line cleaning, and that anything below should be billed as gingivitis treatment. Is this true? If it is, this is against everything I was taught during hygiene school, which is to never leave "stuff" below the gum line during a prophy. Please help me to understand this new code. Thank you.
ANSWER FROM DIANNE GLASSCOE WATTERSON, RDH,Watterson Speaking and Consulting LLC:
No! This is not true. The current descriptor for code D1110 is, “Removal of plaque, calculus, and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors." Is the root part of the tooth structure? Of course it is! What your office is promoting is fraud, plain and simple. D4346 is scaling in the presence of generalized moderate or severe gingival inflammation—full mouth, after oral evaluation. (This code came into effect January 1, 2017.) It is 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 and inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. This should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.
The definition of “… generalized moderate to severe gingival inflammation …” is, when 30% or more of a patient’s teeth at one or more sites are involved. If gingivitis is localized, the correct code is D1110.
Please share this with your team or the dentist so that there is no more misunderstanding. It’s important that you help them understand how to work with the code so that they are no longer committing fraud. Good luck!
Business trip has dental team member wondering if legal lines have been crossed
Uncertified dental employees cause for concern
Not having clear-cut insurance code has dental professional confused
Don't be shy! If YOU have a tough issue in your dental office that you would like addressed, send it to firstname.lastname@example.org for the experts to answer. Remember, you'll be helping others who share the same issue. Responses will come from various dental consultants, as well as other experts in the areas of human resources, coding, front office management, and more. These folks will assist dental professionals with their various issues on DentistryIQ because they're very familiar with the tough challenges day-to-day practice can bring.
All inquiries will be answered anonymously each Thursday here on DIQ.