Thursday Troubleshooter: Dental practice feels it's undercoding

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 protected].

QUESTION: I am in desperate need of guidance. My office still codes most of our adult patients as 1110, despite the fact that my hygienists are completing “more than a prophy.” Our patients receive excellent care, but we are guilty of serious under-coding. My team is all on board, but we do not know how to make this transition go smoothly.

ANSWER FROM PATTI DIGANGI, coauthor of the “DentalCodeology" series of books:
The answer lies in the D4346 code, which facilitates accurate coding for the care dental practices have been routinely performing all along. There is now finally a way to recognize the treatment of gingivitis.

For decades, gingival inflammation has been dumped into the same category as health. The D4346 code can potentially close the loop and elevate the standard of care. With increasing research pointing to the connection between oral disease and medical conditions, the timing is perfect. Early recognition ensures earlier intervention and disease prevention.

Every dental professional sees gingival inflammation daily, whether it’s the hygienist seeing patients for routine care or the dentist performing restorative care. The challenge is not so much with the coding as it is with dental professionals’ thinking.

Though we know there is some level of disease, past thinking and behavior has been that it is not serious until there is bone loss. The imprecise language does not call the condition periodontal disease until there is bone loss. This is like knowing a patient has high blood pressure yet not recognizing it as a disease until there is a heart attack or a stent needed.

D4346 is just the number. This new code provides a metric. With this metric, dental practices have ways to measure the effectiveness of treatment and the progression or non-progression of early disease. In addition to D4346, the D4355 code has been updated for CDT 2018.

So, how does your practice start? The good news is you already have a well-honed office system that includes treatment and procedure coding that you’ve developed and perfected over time. Rather than start from scratch, you merely need to rethink and restructure all of your periodontal protocols. The CDT Shifts 2018 Metrics Drivenbook contains the perio protocols 2018 update.

Code changes do not affect just one part of the office. They can lead to the need for new routines. This is particularly true in the case of D4346. A major change and focus point affecting the entire office are the words “after oral evaluation.” This means the dentist evaluation must come before care is rendered. This is a huge change from the tradition of the dentist evaluation after the hygienist has provided care.

This change is one of eight major focus points to consider when implementing D4346:

1. Oral evaluation before care
2. Therapeutic, not preventive
3. Not age-based
4. All patients must have a perio chart and current radiographs
5. Gingival inflammation must be greater than 30%
6. Diagnosis must be documented
7. Full mouth or no other scaling codes on the same date
8. D4910 does not follow this care

(A credit-card sized reminder card containing these eight focus points is available for free at DentalCodeology.com.)

To ensure a smooth transition to accurate coding, the business team must also be on board. They are ultimately responsible for benefits submission. The clinical team, on the other hand, must provide the documentation necessary to support this coding.

These changes can work in any practice and increase profitability. It will take discussion, coordination, and a new way of thinking. This increases the importance of regular team meetings in which every person participates.

To learn more, the Solving the Mystery of D4346–More than BOP webcast is available for on-demand viewing.

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Don't be shy! If YOU have a tough issue in your dental office that you would like addressed, send it to [email protected] 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 problems 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.

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