Tartar and calculus buildup. It’s a relatively newer code used for patients who have borderline periodontal disease and who have severe calculus buildup. Technically these patients do not fit the criteria for coding for a regular ‘cleaning’ because it does not fall under those parameters. So clinicians have to bill D4346 instead of a regular ‘cleaning’ or prophy code. Some cheaper Insurances have clauses that do not cover d4346 because they are cheap. Under those circumstances the patient is responsible for paying the full amount of that code out of pocket as per their contract with the insurance.

Sometimes we try to be nice and bill out a ‘prophy’ or regular cleaning so the patient doesn’t have to pay out of pocket but technically that isn’t following the rules set forth by the insurance. The d4346 is similar to a regular cleaning and you wouldn’t know much difference sitting in the chair other than a lot more ultrasonic scaler work and the hygienist working harder to remove excess tartare.

So the office was actually trying to stick by ethical coding practices as outlined by your insurance, they tried submitting the procedure a couple times probably with additional narratives and information to try to get it covered so YOU wouldn’t have to pay out of pocket. After exhausting those avenues they had no recourse. YOUR insurance failed to pay on services rendered and you bailed on your responsibility to pay.

Now obviously it would have been better for the office to say here is what your fee will be for this service, you may have to pay out of pocket for the service, but it is really difficult sometimes to get those estimates from insurances. Especially if it is an obscure or difficult to deal with insurance.

So…… anyway that’s the difficulty with medical billing. It’s more of an insurance issue than a Doctor issue. So next time you need to rail on someone about getting ripped off maybe focus on crappy insurances rather than the people trying to make it easier for you. 👍🏻