The Delta Dental Plans Association suggested an hemoglobin A1c (HbA1c) in-office point of service testing code to the Code Maintenance Committee, which determines CDT codes, because:
“A code for the finger-stick capillary HbA1c glucose test procedure will assist in broader adoption of this practice in certain dental settings and practices. In addition, it may facilitate further practice-based studies that will assist in demonstrating the acceptability, feasibility, effectiveness, and cost-effectiveness of chair-side diabetes screening.”
This idea became a code in CDT 2018 as D0411 HbA1c in-office point of service testing. There is no description for this new code. It relates to an in-office measure of hemoglobin HbA1c, a blood test that provides information about a person’s average circulating blood sugar levels in the previous three months.
A Triangular Relationship
Obesity can intensify infections, such as periodontal disease. Cytokines produced by fat cells are known to trigger insulin resistance, which can lead to type 2 diabetes. Diabetes, in turn, is known to increase the risk for periodontal disease. Research suggests that periodontal disease can affect a diabetic patient’s ability to control blood sugar levels. This is more than a bi-directional relationship. It’s triangular.
About 30.3 million Americans are living with diabetes, according to the American Diabetes Association, and about 7.2 million of them don’t know that they have it or that they could be developing serious complications. Another 84.1 million people age 18 and older are living with prediabetes, and up to 90% of those individuals are unaware of their condition.
Complications from diabetes can cut off years of productive lives and interfere with the quality of life. Heart disease and stroke rates are as much as four times higher in diabetics. Fully three quarters of diabetics have high blood pressure. Blindness is the result for as many as 24,000 diabetics each year. Diabetes is the leading cause of kidney failure, nervous system disorders, and amputation. And, it contributes negatively to Alzheimer’s disease risk.
The list of dangers goes on, and dentistry can help. These facts indicate that widespread blood glucose screening may provide high value to our healthcare system.
A simple chair-side HbA1c glucose screening via finger-stick can be used to rapidly identify high-risk patients. The higher the HbA1c level, the poorer the blood sugar control and the higher the risk of diabetes complications. A CDT code for the finger-stick HbA1c glucose test procedure can assist in broader adoption of these tests in dental practices.
Improved Diagnosis and Control
A resource that will help identify patients who might be candidates for the D0411 procedure is the point-of-care prediabetes identification guide prepared jointly by the American Diabetes Association, the American Medical Association, and the Centers for Disease Control.
A specific CDT code creates a metric. Metrics collected by code usage create data based on outcomes. This data becomes the basis for decisions made to generate research grants, developing appropriate third-party payment plans, and collaborative care.
Oral-Systemic Connections
This test speaks the language of medicine and provides signficant opportunities to make oral-systemic connections with physicians. The patient must be informed of the findings of this screening and directed toward resources for followup even if the patient has no phyician.
Adding this screening service brings opporunity as well as responsibility, which includes training for all dental team members. Some components of this screening can be delegated to staff. (Check your local practice acts and rules.) Staff members as well as the dentist will need to be familiar with:
- Performance of the test
- Documentation of results
- Referral loop for patients with and without physicians
- Administrative activities
- How results add to the patient’s medical necessity for dental care
This code reflects the increasing role dental health professionals can play beyond a patient’s oral care and within overall systemic health.
Note: This is an excerpt from the author’s recently published CDT 2018 Shifts Metrics Driven including her 2018 Perio Protocols Flow Chart.
Ms. DiGangi is an international speaker who is passionate about prevention and working with dental professionals to improve practice profitability. She also is the author of the DentalCodeology book series for busy dental professionals. She holds publishing and speaking licenses with the American Dental Association for Current Dental Terminology and SNODENT Diagnostic Coding and recently authored a chapter in the ADA’s CDT 2017 and CDT 2018 Companion entitled “D9000 – D9999 Adjunctive General Services.” She can be reached at patti@dentalcodeology.com.
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