July Antidotes to D4346 Follow-up, Down-coding by Office & Laser Codes

3 July Facebook Misinformation Antidotes

Social media has become the primary means means for businesses, politicians and decision makers to reach their audiences, people are casting newspapers and traditional media aside, instead keeping themselves updated via social networks such as Facebook, Twitter and more. This is no less true for dental coding questions. Daily questions are asked on numerous Facebook groups with a resulting responses that from the ridiculous to downright fraud. The team at DentalCodeology have decided, you need a place to get accurate information.

FB Post: I am getting ready to discuss with our team and wanted to clarify who does the 3-4 weeks follow u for D4346? The hygienist or the DDS?

DentalCodeology FB Misinformation Antidote: A world of incorrect information was posted in response. Great question to which I am going to give my biased response. Hygienists have more specific training and experience probing than DDS unless the DDS is a periodontist. Therefore, the RDH is the best for the follow-up. There are 4 outcomes that can happen at the re-eval. Did you download the sheets from the link I sent? It also gives the coding for each. If the best outcome, complete healing has occurred-great, what we hoped. The code D0171 is the most accurate. The time should be charged in my opinion. As with any evaluation code, the DDS must be part.

So the scenario,

  • D4346 treatment performed.
  • 21-28 days later, patient scheduled with RDH.
  • Use same diagnostic process to determine that D4346 treatment is appropriate care
  • If fully healed, code D0171 with DDS coming in to reinforce that case is healed
  • Recall should not be any longer than 3 months based on biofilm cycles

FB Post: Patient arrives at the practice for routine exam and prophy. Upon evaluation, the patient shows greater than 30% of type 2-3 inflammation in the absence of periodontitis. The treatment plan includes D4346 scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation. The office manager tells the hygienist the patients 3rd party plan does not that code and to use D1110.

DentalCodeology FB Misinformation Antidote: Yikes, this lead to many discussion and suggestions on FB. Many were incorrect. The office manager is telling the hygienist to commit fraud in both documentation and will be submitted fraudulently. The confusion in this case and often happened because the 3rd party carrier changes codes to pay a lesser amount. There is a type of cost containment measure used by many 3rd party payers called the least expensive alternative treatment abbreviated as LEAT. If this clause in a 3rd party agreement, when there are multiple viable options of treatment available for a specific condition, the plan will only pay for the least expensive treatment alternative.

This has traditionally been called under-coding. Or the other end of the spectrum, over-coding which is the intention use of a higher payment code. The confusion arises because it seems to acceptable for a 3rd party carrier to change codes but it is not acceptable for a practice to do so. The term used by 3rd party carriers is remapping. Under LEAT clause, they can change the code. A dental practitioner cannot, and it could be fraud because the documentation is not accurate, it reflects care different than what was rendered.

FB Post: What is the code for a laser decontamination?

DentalCodeology FB Misinformation Antidote: In my first DentalCodeology book More than Pocket Change published in 2013, I identified that as an Eternal Question. The answer unfortunately has not changed.

Procedure codes are procedure based rather than instrument based, e.g. non-surgical periodontal therapy, there is not a different code for use of an ultrasonic scaler vs. hand instruments. The same is true for the use of laser therapy.

 In earlier versions of CDT, there was a code for curettage. Based on the AAP Statement on Gingival Curettage, the procedure code was removed. Though this statement is from 2002, it is still on the AAP website as current. There is not a universal agreement on this position.

In 2017, the DentalCodeology Consortium (DCC) submitted for a code that read this way: “Application of light energy for management and maintenance of acute and chronic inflammation and pain to facilitate healing.” The description read, “Use of light energy to stimulate biological responses in cell function to promote healing.”

The rationale read, “The purpose and intent of light energy therapy is to enable clinical effects to include tissue repair, pain relief, and regenerate cell function.  Research and clinical studies have documented beneficial effects of light energy such as stimulation of fibroblasts and osteoblasts as well as reduction of bacteria.

Studies have shown enhanced, faster and more comfortable wound healing when light energy is used in conjunction with non-surgical periodontal therapy.  Using light energy to further reduce bacteria and pain allows clinicians to accomplish procedures while addressing patient comfort; therefore, increased patient adherence to treatment protocols.

In addition, light energy has been shown to be very effective in bactericidal action on periodontal pathogens making the adjunctive use of antibiotics unnecessary. This eliminates the problem of bacterial resistance and systemic side effects produced by antibiotic use.”

There still remains a huge gap in the codes.
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