2 codes to implement (and get paid for) today
DENTAL BUSINESS SOLUTIONS
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JEN MCGUIRE now
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developed and launched
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program, Total Health
Beyond the Mouth. Contact
her at (800) 372-4346 or
GINGIVAL INFLAMMATION—CODE 4346
Gum health has traditionally been difficult for dental offices
to address. In patient priorities, it falls far behind cavities,
sensitivity and pain, and even a white, bright smile. Despite
this, we know that addressing inflammation is critical to
a patient’s overall health and needs to be treatment planned
accordingly. Recognizing this, the 2017 current dental
terminology (CDT) included a new code designed to fill
the gap between a prophy and scaling, and root planing.
The D4346 code reports scaling in the presence of generalized moderate or severe gingival inflammation, full mouth,
after oral evaluation. This code acknowledges the importance of addressing gingival health before patients deteriorate to the point of periodontal disease.
In the past, these patients have typically been treated
with a prophy and home-care education. For many, this
will not be sufficient to reduce gum inflammation, and
patients will eventually progress to periodontal disease.
When the overall health implications of periodontal disease
are shared with patients, most want to know how they can
“fix” the current inflammation.
1. Identify patients who need treatment for gingival
inflammation. Patients must have generalized—not
acute— inflammation, and no bone loss.
2. Educate patients about the importance of address-
ing inflammation in the mouth. Periodontal disease
increases the risk for diabetes and heart disease, in
addition to other systemic diseases.
1. 2 Prevention of
periodontal disease is one of the most important steps
patients can take to protect their overall health.
3. Calculate applicable insurance benefits and present the treatment plan. Identify the long-term costs
if treatment is not completed.
THERE ARE TWO THINGS every dentist should consider when evaluating
whether to add a patient service. The first and most obvious is: how will the
practice be paid for the new service? Is there a CDT code? Will the procedure
be covered by insurance? Will patients have to pay out of pocket? The second,
and often secondary, question is: How will the service fit into the current patient
appointment structure? Will this require a longer hygiene visit or separate
appointment time? Who will be responsible for presenting the procedure to the
patient? Which team member will complete the procedure? Now that codes are
available for the two services mentioned below, consider how you can
successfully implement these services into your practice to improve patient
health and practice profitability.
DIABETES SCREENING—CODE AVAILABLE IN 2018
One consequence of sustained gingival inflammation and
the development of periodontal disease is the increased
risk of insulin resistance.
3 Given the well-established connection between oral health and diabetes, the ADA and
Code Maintenance Committee announced the addition of
a new code in 2018 that will report the in-office measure
of hemoglobin A1c, a blood test that provides information
about a person’s average circulating blood sugar levels
during the preceding three months.
“People with poorly controlled diabetes are at greater
risk for dental problems,” Ronald Riggins, DDS, Code Maintenance Committee chair, said. “High blood sugar may
cause dry mouth and make gum disease worse.”
1. Identify patients at risk for diabetes. Risk factors for
diabetes include family history of diabetes, high cholesterol,
elevated blood pressure, overweight and obesity, and periodontal disease. Develop your own screening tools to
assess these risk factors and others, or use the “Diabetes
Detection in the Dental Office” screening tool. This tool
was developed by Total Health University cofounder, Susan
Maples, DDS, and validated by Michigan State University
researcher, Saleh Aldasouqi, DDS.
2. Educate patients about the connection between oral
health and diabetes. Patients need to understand that
you cannot safely and successfully treat periodontal disease
without knowledge of associated health conditions.
3. Check at-risk patients for diabetes. Hemoglobin A1c
tests can be performed in the dental office with a simple
finger stick. In just a few minutes, the test provides the
patient’s average blood sugar level for the past two to three
months and classifies it as either normal, prediabetes, or
diabetes. Patients can then be referred to a medical provider
for a definitive diagnosis.
Key to the successful implementation of both of these
codes is the ability to communicate the importance of oral
health and its impact on overall health.
Author’s note: For help educating patients and moti-
vating them to accept treatment, ask a Henry Schein
representative about Total Health University (THU).
THU is an online training and coaching system that
helps dental teams integrate total health patient educa-
tion protocols and systems into the practice.
1. Gum disease and heart
Accessed June 28, 2017.
2. Gum disease and
Accessed June 28, 2017.
3. Periodontitis and
diabetes: A two-way
Center for Biotechnology
November 6, 2011.
Accessed June 28, 2017.