This week on A Tale of Two Hygienists TIPisode we are joined by Steve Pardue, from Elevate Oral Care to talk about a new insurance code for preventative care!
- Treatment After Decay
- Preventative Insurance Coverage
- New Code D-1355
- Precautions
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode, this week brought to you by Elevate Oral Care.
Steve Pardue: Hello, all. It’s Steve Pardue back again with another TIPisode focusing on prevention of caries. This time, I’m introducing a brand-new insurance code to help keep supporting patient’s healthy teeth rather than repairing them after damage has been done.
That’s an important part of today’s discussion. Many times in therapy and treatment side of dentistry, and definitely the insurance or imbursement side, oral diseases are treated during or after the damage has occurred. Restorations are a process to repair damaged teeth. Scaling and root planing is a process to clean pockets after they’ve developed. Even the use of silver diamine fluoride to arrest carious lesions is to repair the damage.
The list of procedures designed to prevent disease from happening in the first place is limited. In fact, in the 2021 Current Dental Terminology book, it has 89 pages of codes, while only 3 of them contain preventive procedures. This is why we’re pleased that a new addition to the short list of prevention codes went into effect on January 1, 2021.
The addition of D1355, caries preventive medicament application – per tooth, is a great step in helping stop tooth decay from beginning in patient’s mouths. This new code is intended to be separate from traditional fluoride and fluoride varnish codes and used for products such as silver diamine fluoride, povidone iodine, silver nitrate, and thymol chlorhexidine products.
The ADA has released a guide to assist using this new D1355 code. You can find it by searching online for “D1355.” It provides clear instruction on how and when to use the code as well as what documentation should accompany the code.
Products like silver nitrate and silver diamine fluoride have had code D1354 since 2016. However, that code is specifically used to arrest existing carious lesions. This code has been used hundreds of thousands of times according to a new research article published in the November 2020 issue of Pediatric Dentistry by Doctor Scully and others. This code, however, is limited to its use on active lesions rather than preventing the disease.
The new D1355 code is intended to prevent diseases before it begins. There are numerous research articles published that show silver diamine fluoride when applied to healthy teeth does not stain, and it prevents tooth decay. The notable article published in the Journal of Dental Research in 2012 by Doctor Liu and others shows that over a six-month period, silver diamine fluoride is as effective at preventing decay as properly placed sealants.
Doctor Jeremy Horst summarized this and many other research articles on preventing decay in a compendium publication in March of 2019. He concludes the annual application of silver diamine fluoride to high-risk surfaces appears to be the most cost-effective approach to preventing dental caries. Since Doctor Horst’s articles, there have been six other publications confirming silver diamine fluoride’s ability to prevent or reduce the incidence of tooth decay.
With this new code and the preventive use of silver diamine fluoride, there comes some new precautions to take as well. Silver diamine fluoride will not stain healthy enamel or dentin. However, even the smallest decayed or demineralized areas will stain. Also, freshly planned root surfaces can stain too.
Be sure to provide your patient the various treatment options and associated side effects such as unintentional staining of hidden caries, isolate the treatment site, and apply specifically to those treatment sites. Keep in mind, any sites that are early white spot lesions and stain accidentally act as a disclosing agent for the patient and arrest these sites. Those locations can still mineralize and may lose their stain through time.
Using these preventive products and now the codes to support them are the first step in lowering the caries rates in our patients. Almost a century after fluoride’s introduction into dentistry, we’re beginning to see the effects it can have for our patient’s health.
These new codes may not be reimbursed by insurance providers immediately, but as they see the code used more frequently, it will gain coverage in plans. D1354 is a prime example of this process. In 2016 when it was introduced, there was no coverage at all for the code. Today, over 35 Medicaid programs cover the code, and numerous insurance plans and providers reimburse for its use.
As hygienists, you’re on the front lines of prevention in dental offices, and we thank you for it. We’re working to provide tools and continuing education support as you provide these therapies to your patients.
To learn more about D1355, silver diamine fluoride, prevention in general, or to schedule a AGD PACE continuing education program in your practice, either virtually or in person, contact us at 877-866-9113 or info@elevateoralcare.com
Michelle Strange: Thanks for listening to another TIPisode, and thank you to Elevate Oral Care for sponsoring this week’s episode. You can find out more about their great products at elevateoralcare.com.
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