Thursday Troubleshooter: Codes D4341 and D4342, and new code for treating gingivitis

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QUESTION: What’s the difference between D4341 and D4342? Also, I hear there’s a new code coming out for treating gingivitis. Can you please explain that for me?

ANSWER FROM PATTI DIGANGI, coauthor of the “DentalCodeology" series of books:Codes D4341 and D4342 have a similar description in CDT 2016. The only differences are whether the disease being treated is four or more teeth per quadrant or one to three teeth. The most accurate code determines the correct diagnosis.

Dental benefit carriers write policies with a variety of parameters for periodontal care coverage although dental practices rarely see them. An example from United Concordia: “For PSRP to be considered for a benefit, the diagnostic materials must demonstrate the following, consistent with professional standards:

• Clinical loss of periodontal attachment and/or
• Radiographic evidence of crestal bone loss and changes in crestal lamina dura and/or
• Radiographic evidence of root surface calculus”

(Note: Policies differ. This is a sample only.)

My book, “DentalCodeology: More than Pocket Change,” includes a 20-year-old patient named Kelly with a periodontal diagnosis on Nos. 14 and 15 of aggressive periodontitis with 2 mm bone loss and plaque-induced gingival disease modified by systemic factors of pregnancy. (See AAP Disease Classifications.) Her non-surgical treatment plan is:

• D1110 prophylaxis—adult
• D4342 periodontal scaling and root planning—one to three teeth per quadrant Nos. 14 and 15
• D4921 gingival irrigation, per quadrant UL

What is most important is to include Kelly’s dental-medical necessity in Box 35 Remarks on the claim form: “Plaque-induced gingival disease modified by systemic factors of pregnancy, and Nos. 14 and 15 aggressive periodontitis with 2 mm bone loss. (See Thursday Troubleshooter January 2016 on writing dental-medical necessity narratives.)

What if Kelly also had radiographic evidence of calculus on Nos. 12 and 13? The coding for the non-surgical periodontal care becomes:

• D1110 prophylaxis—adult
• D4341 periodontal scaling and root planning—four or more teeth per quadrant UL
• D4921 gingival irrigation, per quadrant UL

Kelly’s dental-medical necessity changes to, “Plaque-induced gingival disease modified by systemic factors of pregnancy, and Nos. 14 and 15 aggressive periodontitis with 2 mm bone loss with radiographic calculus Nos.12 and 13.

New gingivitis code
The big news is that January 2017 will bring us a new CDT code for patients who present with moderate to severe gingivitis. This is great news, but the parameters for diagnosis of periodontal disease will change. The code passed the ADA Code Maintenance Committee (CMC) reading this way: “Scaling in presence of generalized moderate or severe gingival inflammation—full mouth, after oral evaluation.”

Once we have this new code, Kelly’s non-surgical care may be:
• DXXXX scaling in presence of generalized moderate or severe gingival inflammation—full mouth, after oral evaluation
• D4341 periodontal scaling and root planning—four or more teeth per quadrant UL
• D4921 gingival irrigation, per quadrant UL

But maybe not. This new code says full mouth, which doesn’t make sense with the D4341 code. The ADA will be coming out with a Q&A on this new code soon. Also, watch for “DentalCodeology: The New Gingivitis Code book,” coming very soon.

This new code has passed but has not been given a CDT Code number. It cannot be used until after January 1, 2017. Insurance companies may take a few months after that to recognize this new code if it becomes part of their coverage under a policy. Minor tweaks in this verbiage may still occur.

Please remember: You cannot use this code yet because it does not exist until CDT 2017.

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