For years, dental practices were stymied about when it was appropriate to report debridement code D4355 (Full mouth debridement to enable a comprehensive evaluation and diagnosis on a subsequent visit). It was unclear whether a dentist could examine the patient the same day, or whether this code was exclusive to patients in nursing homes or other facilities. Fortunately, changes on the horizon for 2023 aim to answer some questions and make this service easier to report.
To get a handle on how you’ll report dental code D4355 in 2023, check out a few key pointers.
Look for New Term Added to D4355 Description
When the calendar turns to 2023, you’ll find a revision to the D4355 description. Even though only two words have changed, it significantly alters how dental practices will view this code. Starting January 1, you’ll see the description as follows:
- D4355: Full mouth debridement to enable a comprehensive oral periodontal evaluation and diagnosis on a subsequent visit
In the past, D4355 was overused by many dental practices that didn’t quite understand how to use it correctly, but the new descriptor makes clear that you’re performing the debridement specifically so a full and comprehensive periodontal evaluation will occur at a later date.
Here’s why: The hygienist or dentist will perform debridement for patients who have such severe buildup of plaque and calculus embedded in their mouths (between teeth, around the gums) that it’s impossible to perform a thorough evaluation of the patient’s teeth and gingival structures. Once the debridement is done, the patient will likely experience inflammation, so they’ll take time to heal before returning to the dentist for a full comprehensive periodontal evaluation.
You Won’t Report D4355 Frequently
Debridements aren’t common among healthy patients, and if you do see a patient who needs debridement prior to a periodontal exam, you’ll usually only perform it once or twice in a patient’s entire lifetime. That’s because once the debridement occurs, the patient will be advised to perform oral hygiene measures to avoid having to do it again.
If the patient is not capable of caring for their own teeth, the hygienist will inform their caregiver on steps they should take to avoid significant buildup in the future so additional debridements aren’t necessary.
D4355 Often Applies to Patients in Alternative Settings
Many hygienists report D4355 outside of private practice. This can be due to several reasons, but it’s often because patients who are well enough to present for regular dental visits don’t experience buildup severe enough to warrant D4355. So the dentist or hygienist might perform debridement in nursing homes, patients’ homes or assisted living facilities more often than in the office.
Include a Description of Why You Performed Debridement
If you report D4355, you should submit a narrative explaining why it was necessary, including a description of the procedure, the length of time since the patient’s last cleaning, any photos or X-rays showing the calculus deposits, and statements regarding why the patient presented.
For instance: Today I performed debridement on Mrs. Smith, a patient with Alzheimer’s disease who has been in a memory care facility for six years. Her daughter noticed that she was wincing whenever she chewed, so she asked us to consult. Mrs. Smith had not seen a dentist since 2015 and a visualization of her gingival structures and teeth were impossible due to significant buildup of calculus and tartar. We performed a complete debridement, which she tolerated well. We will return to the memory care facility in two weeks to perform a comprehensive periodontal examination on Mrs. Smith. Her daughter and the memory care staff were advised to give her ibuprofen for discomfort and to call our office if any significant bleeding occurs.
Want more tips about coding dental hygiene services? Listen in as Kathy S. Forbes, RDH, BS, leads you through everything you need to know so you can collect more for your dental practice! During her 90-minute presentation, “New Code D4355: Stop Losing Money on Dental Hygiene Services,” Kathy will cover the changes to D4355 and much, much more.
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