Is It Perio or Preventive? Clearing up the Codes

By Patti DiGangi, RDH, BS on September, 20 2019
Patti DiGangi, RDH, BS

As a navigator and long-time clinician, Patti guides audiences through the rough waters of coding. She believes dentistry is no longer just about fixing teeth; dentistry is oral medicine. Her efforts have assisted thousands of professionals to code more accurately and efficiently.

When it comes to codes, the lines between perio and preventive have been fuzzy. With the addition of the D4346 code, the fuzzy didn’t clear up much. But clear boundaries do exist. 

Codes can help with clarity, and at the same time can create more confusion. The definition of a prophylaxis in CDT coding has changed several times. Most often, we don’t see the definition. Our software system usually lists only the name of the code. 

What is perio? That’s easy … or not. Often perio is defined as bone loss. Yet we all know the term periodontium means the tissue that surrounds and supports the teeth. Inflammation of the periodontium-gingivitis is perio. 

Dental hygienists know the value of a preventive prophy … except that idea isn’t supported by research.

Wait! Allow me to take the stake out of your heart.

Think about how many patients you’ve seen who are 100% healthy. Are you 100% healthy? Life is dynamic and 100% health might happen, but it’s a moment in time.

Let’s use the idea of percentages – a number is easier to grasp than fuzzy words like light, medium or moderate. With D4346 code, inflammation needs to be greater than 30% of the teeth. So that means if inflammation is less than 30%, then D1110/1120 treatment is appropriate.

I don’t know about you, but the patient better have 30 teeth for me to do that math! Good news, there are apps that will easily do the math, as well as provide the documentation. One new option is the BOB Score by Curaprox.

The D4346 code says this percentage is in the absence of periodontitis. This is again where our words get confused. Periodontitis doesn’t mean bone loss, it means inflammation of the periodontium which includes gone and soft tissues. 

DiGangi Formulas
Again, think about your patients: don’t you have patients who had periodontitis that was treated and now they’re stable? Do they have periodontitis? No, they can be healthy with a reduced periodontium. 

These aren’t words we often use. It’s part of the updated AAP Classification system. Some of the beauties of that system are categories for health and stabilized cases.

Taking this back around to coding, if the patient is healthy with a reduced periodontium, what’s the treatment? You’re thinking, once perio always perio … not so fast. There are several scenarios. 

First, if there’s a reduced periodontium, do you have a record of surgical or non-surgical treatment? If you have no record, then D4910 isn’t accurate. What if the patient tells you they had “deep cleaning” – yikes, what does that mean?! The patient just telling you and the presence bone loss doesn’t mean D4910 is the accurate code.

That brings us back to inflammation. If there's a reduced periodontium and we have no record of perio therapy, it kicks back to percentages.

Less confused? Maybe or maybe not. This isn’t what we’ve traditionally been thinking and doing. I hated math (still do), yet what I can see now is how these equations can take away the fuzzy.


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