Episode 88: How to Bill D4346 - From Bloody Prophy's to Perio Conversions
Description
Got questions? Send Ericka a Text!
Are you leaving money on the table while your patients remain undertreated? After analyzing over 300 dental practices across the country, I discovered a shocking truth: the average dental practice with a full-time hygienist treats only 17% of the periodontal disease they diagnose. That means 83% of diagnosed disease goes completely untreated—a staggering gap between diagnosis and care.
This episode dives deep into the "hidden opportunity" within your hygiene department by exploring D4346: scaling in the presence of generalized moderate to severe gingival inflammation. This often-misunderstood code bridges the critical gap between a standard prophy (D1110) and scaling and root planing (D4341/D4342). For patients showing clear signs of gingivitis without bone loss—bleeding on probing, inflamed tissue, pseudopockets, and plaque that doesn't respond to routine cleaning—continuing to perform prophies isn't prevention; it's undertreatment.
I walk you through a comprehensive, step-by-step process for properly implementing D4346 in your practice, from accurate diagnosis and bulletproof documentation to effective patient education and ethical billing. We cover common challenges including insurance downgrades, particularly when carriers like Delta may pay less for D4346 than for a prophy, and how to handle these situations without compromising ethics or revenue. The key message: this code is based on diagnosis, not difficulty or time spent, and represents therapeutic care designed to heal tissue, not maintain it.
Whether you're a dental biller, office manager, hygienist, or dentist, this episode provides practical guidance for transforming your approach to gingivitis treatment. The benefits extend beyond proper coding—you'll deliver better care, improve patient outcomes, and optimize practice revenue. Pull a few charts this week and see how many of your "prophy patients" actually qualify for D4346. The results might surprise you.
Join The Biller Acceleration Mentorship Wait List Here: (Only 5 Spots Left in 2025!!)
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Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.
Email Ericka:
ericka@dentalbillingdoneright.com
Schedule a call with Ericka:
https://calendly.com/ericka-dentalbillingdoneright/30min
Perio performance formula:
(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)
Delta Dental Locum Tenens Form:
https://www1.deltadentalins.com/content/dam/ddins/en/pdf/dentists/locum-tenens-form.pdf