Be it performing small-scale procedures or a large-scale surgery, each process itself requires you to report or claim a dental code to ensure a smooth inflow of payments. Hence, understanding these codes is important for both you and your patients to identify specific dental procedures and services and thus, get proper reimbursements.
SRP Code D4341
According to the ADA, the scaling and root planing (srp) dental code d4341 is a therapeutic procedure, not a prophylactic procedure and is to be used for the instrumentation of the crown and root surfaces. It involves a deep cleaning procedure to remove the significant buildup of plaque, calculus, and other deposits from these areas. Root planing in specific is responsible for removing rough substances such as dentin and cementum that cause removal of soft tissue.
It is different from other srp codes as this is specifically applicable for patients that have experienced a subsequent bone loss or a periodontal disease that may lead to a presurgical phase. Moreover, according to the ADA definition, d4341 only qualifies for the treatment of ‘four or more teeth per quadrant’ that have been affected and is considered the first rather than a follow up or final scaling treatment.
Difference Between D4341 and D4342
While both the codes are almost similar, the only difference that exists between them is on the number of teeth the procedure is performed. The dental code d4341 is defined by ‘perio scale and root pin 4’ while d4342 is defined by ‘perio scale/root pin-1-3th quad’.
This means that if the bone loss is only visible on one to three teeth, then d4342 needs to be claimed; however, if it’s visible on four or more teeth per quadrant then d4341 needs to be reported.
Many professionals often get confused between the two and may claim the wrong one. Hence, it is very important to know the difference, so your claim does not get denied.
Why Do D4341/D4342 Dental Code Claims Get Denied?
There has been a growing number of claim denials concerning the d4341 dental code. While you may think you’re reporting the correct procedure code, however, this might not always be the case. Most dentists often confuse the services that come under d4346 as d4341 or d4342.
The dental procedure code D4346 (scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation) was introduced by the ADA in 2017. According to the ADA this code is described as “a procedure used for the removal of plaque, calculus and stains from supra- and sub-gingival tooth surfaces in case of a 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 should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.”
Previously, there was no specific code available to report therapeutic treatment of patients dealing with a generalized moderate to severe gingival inflammation with or without pseudo-pockets and with no evidence of bone loss. Hence, this ‘no bone loss’ treatment was often claimed by dental professionals under the code D4341. However, after the introduction of D4346 procedural code, this treatment is no longer eligible for these codes used previously.
Another reason for the claim denial may be due to the probing depths which specify details regarding the loss of attachment. The insurance companies require you to submit periodontal charting reports for the D4341 and D4342 procedures which should include at least 4-6 mm pocket depth (Case Type II periodontal disease and early bone loss). If the probing depth is less than 4 mm, the insurers will not pay for it.
Documentation Requirements For D4341
For most dental benefit plans, D4341 can be billed once every two years, while for some other carriers, it is usually once every 36 months.
Moreover, as mentioned above, D4341 is only to be used in case of a ‘bone loss’. Therefore, many insurance companies now ask for radiographic evidence of bone loss in order to process the claims made. A failure to provide such a document is thus bound to result in a claim denial.
Thus, it is recommended for you to first confirm with dental insurance companies the specific requirements they have in place for certain codes in their benefit plans, in order to avoid any potential reimbursement issues down the line. You may also contact a dental billing company to avoid any confusions you may face.
To summarize, D4341 is a therapeutic code that is only to be used for scaling and root planing if there is a bone loss visible in at least four or more teeth per quadrant. It is vital for dental emergencies as it prevents periodontal diseases. It is imperative to know the differences between this and D4346 to prevent any claim rejections.
If you have any further questions regarding other dental codes, procedures or dental billing, Zap Dental Billing is here to help. Don’t forget to contact us in case of any queries!