Code Tip: Coding for D4346

This newer code is a bridge between a preventive prophy and scaling and root planing.  When neither fit the patient’s condition the use of D4346 may be applicable if the following are present.

Use this code when all of these are present:

  • Evaluation is complete;
  • Patient is diagnosed with Generalized Moderate Gingivitis or Generalized Severe Gingivitis;
  • Generalized pocket depths 4mm or greater are present and charted
  • Moderate to severe bleeding on probing is present; AND
  • Radiographs show that there is no bone loss.

Do NOT use this code in any of these scenarios:

  • Patient is diagnosed with any classification of periodontitis (vs. gingivitis);
  • Patient is diagnosed with Localized Gingivitis (vs. generalized);
  • Patient is diagnosed with Slight Gingivitis (vs. moderate or severe);
  • Bleeding on probing is localized (vs. generalized);
  • Attachment loss is present;
  • Radiographs show bone loss;
  • There is too much plaque and calculus for an exam to be done.

Include in the insurance claim submission:

  • Complete periodontal charting, showing pocket depths;
  • Narrative (or copy of patient notes) stating the diagnosis;
  • Narrative describing bleeding on probing status if not included on perio chart;
  • Narrative stating when last prophy was done, if longer than 12 months;
  • Narrative describing other contributing factors such as plaque deposits, calculus deposits, description of gingiva appearance, pain, malodor;
  • Intraoral photographs if they help illustrate the gingival condition.

eAssist Helpful News and Billing Tips; Edition #120


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