November Coding Facebook Fallacy-Can an RDH diagnose Periodontitis?

Post from FB: So as a RDH I know we are not allowed to diagnose periodontits but I thought we were allowed to diagnose gingivitis. Am I wrong about this? I have been putting in my notes “generalized/ localized , marginal/ moderate/ or papillary gingivitis” and also “Generalized/ localized, reduced periodontium/ healthy periodontium due to….. like bruxing and clenching or past ortho or past periodontal infection that led to getting SRP etc..  Also I looked online but I could only find the hard copy plus online copy of the cdt codes 2020 for a cost. So does this mean theres no free online pdf version of this? 

DentalCodeology Response:The diagnosis discussion is one that must be at the start. Not only can be make a diagnosis, we are required by our education to do so. I know you heard in school and its said over and over again, we cannot but this is wrong. This is not a state-by-state issue in a general sense. Let me explain.

Standards of care are generally determined in a court of law. Where would a lawyer and judge look for what is ‘standard’ for a profession? Rules, laws, practice acts, education guidelines, white papers and standards set by the profession. Dental hygiene education standards are set by the Commission on Dental Accreditation. Part of that standard is to be taught the dental hygiene process of care.

Are you familiar with the ADHA Standards for Clinical Dental Hygiene Practice revised in 2016? It is the minimum standard for the practice of dental hygiene. Membership has no bearing on it.  I mention minimum because standards are not the highest we try to attain, rather, they are the lowest we can go no lower.

Quoted from the Standards: The dental hygiene diagnosis is a key component of the process and involves assessment of the data collected, consultation with the dentist and other health care providers, and informed decision-making. The dental hygiene diagnosis and care plan are incorporated into the comprehensive plan that includes restorative, cosmetic, and oral health needs that the patient values. All components of the process of care are interrelated and depend upon ongoing assessments and evaluation of treatment outcomes to determine the need for change in the care plan. These Standards follow the dental hygiene process of care to provide a structure for clinical practice that focuses on the provision of patient-centered comprehensive care.

There is nothing in those standard about what you are diagnosing. In other words, gingivis vs. periodontitis is not part of the discussion. A diagnosis is a diagnosis. The DH diagnosis is part of the dentists diagnosis.

The documentation needed to support our diagnosis changed with the addition of the D4346 code. Though by the Standards, we should have all of the necessary documentation already, the tradition has not called for routine documentation of bone height and inflammation. Bleeding and inflammation are not always the same. We both have had patients with inflammation but no BOP. You know when we have probed with no bleeding but then place an instrument and it gushes. For the D4346 code, the description requires >30% inflammation type 2-3 in the absense of periodontitis. That is not show by your current documentation.

As far as the codes book, believe me I know the costs. The ADA ‘owns’ the codes. What that means is everyone has to pay to get them. For me, I hold licenses to speak and write on CDT codes and pay dearly each year for those licences. ADA acutally gets a % of everything I do. Can you imagine if they charged offices that same way. To be honest, it’s a small investment of <$100 each year.

I invite you to join my DentalCodeology Insiders group. We are proactively submitting for new and revised codes as well as lobbying to get an RDH on the codes committee. Until RDH have a vote, our voices won’t truly count. We need a larger voice and would love to have you join us. I think rubbing elbows on a similar journey can help to learn more too.

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