04 Oct D4346 is a new code coming January 1, 2017 from the ADA.
D4346 is scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation.
The removal of plaque, calculus and stains from supra- and subgingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. It is not to be billed in conjunction with prophylaxis, scaling and root planing, or debridement procedures. This code was designed to somewhat close the gap between the preventive prophy and the periodontal disease evidenced scaling and root planing. It most likely will be subject to policy provisions and frequency limitations like prophys. The point is code as you diagnose it not how you think the insurance company will pay it.
It is important to know the difference between gingivitis and periodontitis. It will certainly help to use the ICD-10 codes to help with the diagnosis for claim submittal.
Gingivitis – Inflammation of the gingiva as a response to bacterial plaque on adjacent teeth; characterized by erythema, edema, and fibrous enlargement of the gingiva without resorption of the underlying alveolar bone.
Gingivitis is classified in ICD-10
K05.00 acute, plaque induced
K05.01 acute, non-plaque induced
K05.10 chronic, plaque induced
K05.11 chronic, non-plaque induced
Periodontitis – Inflammatory disease of the periodontium occurring in response to bacterial plaque on adjacent teeth; characterized by gingivitis, destruction of alveolar bone and periodontal ligament, apical migration of the epithelial attachment resulting in formation of periodontal pockets, and ultimate loosening and exfoliation of teeth.
Periodontitis is classified in ICD-10
K05.20 aggressive, unspecified
K05.21 aggressive, localized
K05.22 aggressive, generalized
K05.30 chronic, unspecified
K05.31 chronic, localized
K05.32 chronic, generalized