D4355: GROSS DEBRIDEMENT – 2023 UPDATE

Welcome to Tuesday Tips with MODPractice!

Code D4355 has been one of the CDT codes that for YEARS has been driving dental billers bonkers! We JUST wrote about this code in November.

But, there’s some great news! The ADA has FINALLY updated the nomenclature and you can now bill an exam on the same date of service as the D4355. About time since legally speaking, an exam is required to diagnose necessity for the gross debridement.

Previously, you could only bill D0191: Limited clinical inspection that is performed to identify possible signs of oral or systemic disease, malformation, or injury, and the potential need for referral for diagnosis and treatment.

So, what changes with the new 2023 update?
The nomenclature change now states:
D4355: full mouth debridement to enable a comprehensive oral periodontal evaluation and diagnosis on a subsequent visit. 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. Not to be completed on the same day as D0150, D0160, or D0180.

What you now able to bill in conjunction with D4355:
D0150: Comprehensive Exam
D0120: Periodic Exam
D0191: Limited Clinical Inspection

What you still CAN’T bill in conjunction with D4355:
D0180: Comprehensive Periodontal Evaluation (must be completed on a subsequent date of service)

What you MAY bill but MUST have a detailed narrative:
D0140: Limited Exam (Narrative MUST state that patients complaint is gum related and that the condition is caused by plaque and/or calculus).

Most of the time, you’re going to see this with new patients so you’ll be able to bill the D0150 but on occasion, you may need to bill the D0120 or D0140.

Supporting documentation should include: a detailed narrative utilizing a SOAP note template, FMX or Pano, and intra or extraoral photographs clearly showing the amount of plaque and calculus.

You can access the ADA Guide HERE.

Please keep in mind that even if you jump through all of the hoops, this is not a guarantee of coverage.  Best practice is to thoroughly review the treatment plan with your patient and ensure they sign a financial agreement that reinforces the fact that the patient is responsible for the cost of their treatment regardless of whether or not the insurance company decides to cover the treatment they need.

Interested in learning more about Revenue Cycle Management for your practice? Contact us today!