b'FOR YOUR PRACTICEAsk the Coding CoachDear Coding Coach: I understand the use of D4346, scaling in the presence of generalized moderate or severe gingival inflammation, but what documentation do carriers require when I submit for reimbursement? This code became effective in 2017 and was developed by a workgroup of the Code Maintenance Committee after multiple requests over the years for a difficult prophylaxis. The workgroup incorporated a diverse point of view and included representatives from the American Academy of Periodontology, American Dental Association, Academy of General Dentistry, American Dental Hygienists Association, and insurance carriers. It is meant to be used when there is more inflammation than what is normally seen during an adult prophylaxis and a more involved procedure will be required. The scaling and root planing codes would not apply since no bone loss is present and root planing is notI performed a gingivectomy in the mandibular performed. Pseudo-pocketing, caused by the inflammation,anterior as well as a frenectomy interproximal to would be evident. This is a full mouth procedure.teeth #24-25. I submitted for reimbursement but the frenectomy was denied. Should I resubmit for Codes are not developed specifically for reimbursement butthe frenectomy? exist to accurately describe what treatment is performed. If a procedure code exists, that does not mean that it will beYou were not incorrect to submit for both the frenectomy reimbursed by a third-party payer. Regardless, you shouldand the gingivectomy, but in this case, the carrier still submit to a carrier for the treatment being done.was also correct. In many cases when more than one treatment is performed, benefits will be applied to It is difficult to state exactly what is required whenthe most inclusive procedure; in this case, it was the submitting for D4346, since each carriers requirementsgingivectomy. For example, the same would apply if are different. In this case, the AAP recommends periodontalosseous surgery was done and crown lengthening was charting, radiographs, either recent BWX, or an FMXalso performed at the same appointment in the same that show bone height, and an intraoral photo that clearlyarea of the mouth. The osseous surgery would be demonstrates inflammation. A short narrative might also bereimbursed, and the crown lengthening would not since needed, particularly if the inflammation is related to a clinicalthe crown lengthening would be considered as included issue such as orthodontic appliances. Follow the AAP on social media! Reimbursement for D4346 varies greatly. Some carriersin the osseous surgery. This is a common plan limitation with most carriers. consider it the same as a prophylaxis and even may count it as one of the annual maintenance or prophylaxis appointments. Some do not cover the code, and someSubmit your third-party questions to carriers reimburse equivalent to one quadrant of scaling andinsurance@perio.org. Members root planing. Remember that some plan limitations may exist, limiting use of the code to once per patient, or once during awith coding questions or difficulties specific timeframe.with insurance claims can also contact @amer_acad_perio Another factor to consider is that if a patient requires use ofPam Throw at 312-573-3241 or email pamela@perio.orgthe D4346, they may also require a second appointment for a re-evaluation or a prophylaxis within a short period of time. It is always beneficial to mention to the patient that one or even both procedures may not be covered.Interested in hosting an AAP Instagram Takeover? AAP Periospectives| 23Email Maggie Matamoros, marketing specialist, at maggie@perio.org for more information.102378_AAOP.indd23 3/18/212:36 PM'