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Fast Facts: Coding Edition - D4355

Fast Facts

Fast Facts: Coding Episode 4

[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 D4355, which is more affectionately referred to as that debridement code. Let's go over the official definition before we get into the nitty gritty. It is a full mouth debridement to enable a comprehensive oral evaluation and a diagnosis on a subsequent visit. (That's important!) Now here's the description. Full mouth debridement involves the preliminary removal of plaque and calculus that interferes with the ability of the dentist to perform a comprehensive oral evaluation. It's not to be completed on the same day as D0150 D0160 or D0180. Now, those are what we call the more comprehensive evaluations. D0150 course is the big comprehensive evaluation, D0180 is the periodontal evaluation, and D0160 is a comprehensive follow up to anything that's found in the other evaluations. The reason that debridement is performed is to enable an evaluation. This is for situations where the patient comes in and there's just so much stuff on the teeth. I consider it to be the fuzzy, just full of stuff, and when you see that on the teeth, you know that there's no way that you can actually get in there to do any proper diagnostics. The X rays that you take are going to be just full of plaque and calculus, and that's fine, and normally we want to capture that, but in order for you to do a comprehensive evaluation with complete periodontal probing and an accurate look at what's really going on, soft tissue wise, sometimes that debridement is just too much. And so what ends up happening is that we remove all of that surface stuff and let the patient heal for whatever the prescribed amount of days is, and then have them come back, and then we can do a more proper and more comprehensive evaluation. Some offices take the radiographs at the first appointment when the patient presents with this condition, and some offices will take it afterwards. Of course, letting the patient know that that's going to be the situation. There are lots of rationale either way, some officers want to do a good before picture, and so they'll take radiographs. Some offices would rather take preliminary radiographs, not really a complete set, just almost a "lookSee" and then do a more complete set when they come back. Every office is going to be different. You're going to have to come up with your own guidelines for that.
I'll give you a tip here if you are able to take good intraoral images prior to the debridement and then after the debridement. Those are fantastic patient education tools. Not only can you use it for that particular patient, but it's really good to show other patients that it can indeed get to be this bad should they skip their cleanings. There's lots of reasons to use those particular images and of course you would need to make sure that you have the patient's permission to use those or remove any of the identifying information from the image. But I do find when I'm dealing with that particular patient showing them before and afters that are that drastic and change can really help out with portraying the trust, making sure that they understand that you have their best interests at heart and having them move forward with accepting treatment.
When it comes to getting this covered, remember if you do submit for a comprehensive evaluation on the same day as a debridement, they'll likely pay the comprehensive evaluation and not the debridement. The code specifically states that they cannot be both paid at the same time. So how do you determine that a debridement is done if you don't do an evaluation? Well, you are doing an evaluation. You have two options for you, D0140 is your limited evaluation and indeed this is the code that I see used the most in this scenario. So you would bill out D0140 which is the limited and the D4355. Then the next appointment you would do the comprehensive evaluation and then whichever if you're doing the preventive prophy, if that's indicated or if you're moving right into advanced treatment. I hope that this has been helpful and we will see you on the next edition.
[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 We'll see you next week for another Fast Fact!

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