Fast Facts: Coding Episode 3
[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Coding Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Teresa Duncan, MS.
[Teresa Duncan, MS]
Hello and welcome to another edition of your Coding Fast Facts. Today we're going to talk about D4381. This is the localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue and it is a per tooth code. Now let's go over the actual definition of it before we go into some of the exclusions, clauses and documentation needs for it. It is an FDA approved subgingival delivery devices containing antimicrobial medication. They are inserted into the periodontal pockets to suppress the pathogenic microbiota. These devices slowly release the pharmacological agents so they can remain at the intended site of action in a therapeutic concentration for a sufficient length of time.
Now I remember when these were big on the market and you had some confusion, you did have application of 4381 materials and there's lots of different ones out there, so I'm not going to be products specific on here, but the 4381 materials were used sometimes even in conjunction with scaling and root planing and osteo surgery. 4381 though if you are talking with a patient and perhaps this is previous to doing any active therapy, you can let them know that this is something that you anticipate having to use. And I would always do that so that you can prepare them for it. It is an additional cost. You may or may not end up using it, but I would rather you prepare them for it ahead of time and then that way it's not just another added on bill. Many of our patients have to budget for a lot of the procedures that they have done in our office. And so I'd rather them be able to cross this off their list, then surprise them with it down the road.
Now what's interesting about this is it should not be placed at a prophylaxis appointment because there should be active disease, right? Usually this is indicated when there's an active disease state going on. So that's one thing to keep in mind when it comes to the submission for this into the insurance carrier for benefits. What you're looking at is very similar to your scaling and root planing and your Osteo surgery procedures. You're going to be sending in probing, full complete periodontal probing within twelve months. So again, current periodontal probing and radiographs, and we usually like to have those within one year. I know that there are certain benefit plans that will allow you to go two years out, but I think with your disease state and how you're already monitoring the scaling and root planing, you probably have radiographs for that area that are within one year.
You also want to have noted the stage of the patient when they presented and what the current grade is for them and of course if your documentation is up to speed with the AAP guidelines you'll already have that templated and ready to go so that your dental biller like me could just come in and screenshot your clinical notes and that would be more than enough to get 4381 paid if indeed there are benefits available for it.
Now some of the limitations that go along with 4381 and sometimes limitations don't make a lot of sense; they're just cost control measures. There are many plans that will only limit reimbursement for two teeth per quadrant and so this is a per tooth code and so per quadrant you could definitely have more than two teeth that need this kind of treatment. Now if that's the case just remember that the benefit may be limited to two teeth per quadrant but you should be able to assess that additional fee and get that from the patient. The patient shouldn't get two, three, four teeth free just because they have insurance they should have some out of pocket, so make sure that your dental biller reads the explanation of benefits really well and make sure that that's not being asked to be written off because that should be billable to the patient. It is a definite procedure that you provided and if you've looked at the invoices for any of these materials it's not cheap to provide them so I hope this has been helpful and until the next coding fast facts thank you so much for listening.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts - Coding Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at www.dentistrx.com. We'll see you next week for another Fast Fact!