Code D0411, HbA1c in-office point-of-service testing: The new face of dentistry

Imagine you’re standing at Grand Central Station in New York City. While looking at the people in your immediate vicinity, you start counting—one, two, three, one, two, three, with every third person turning blue. As you count outside of your area, the blue continues to multiply, and the crowd of blue becomes more apparent. Would you believe that each person in this growing wave of blue is currently developing resistance to insulin, the hormone crucial in regulating blood glucose?1 This puts each of them at an increased risk of becoming diabetic.

The dental industry is in a dynamic space, with the continued evolution of oral health and its ever-present, augmented impact on overall health. Every year the industry is given new studies, tools, and codes to practice innovative dental medicine, which allows clinicians to serve patients with the care they expect in the 21st century. In 2018, we were given a dynamic CDT code—D0411,diabetes screening for HbA1c—that has continued to catapult dentistry into the total health arena.

The new code is bringing more crucial services to dentistry. Here’s why.

Benefits to patients

According to the CDC, 85 million people in the US are blue, or prediabetic. Of those blue, nine out of 10 are getting out of bed each day with zero knowledge that they’re at risk for developing diabetes. Even more staggering, only one-quarter of the 29 million people living in the US with diabetes has been diagnosed.

With what dentists know, they can use the proper tools to identify and evaluate asymptomatic patients. Screening in dental offices is an opportunity for clinicians to create patient-centered care by integrating patient touch points and encouraging collaboration with primary care professionals, which will put dentistry at the entry point of our medical care system.

Benefits to practices

All dentists want customized treatment plans for their patients. During the most crucial step in patient flow, which is reviewing the patient’s medical and dental history, we analyze data and project the most attainable and successful treatment possible for the patient. Incorporating glucose screening and gaining knowledge of elevated blood sugar that could possibly inhibit healing due to the stiffening of arteries and narrowing of blood vessels can help dentists create that tailored plan. Infections, delayed healing, and periodontal disease are all areas in which proper screening can aid clinicians in better patient management. The new standard of care in treatment planning success rates starts now.

Implementation

Screening can be completed chairside with an HbA1c glucose monitor. This allows the dentist to evaluate a patient’s A1c, which is the person’s average blood sugar level over the past two to three months. The procedure code does not describe simple testing of the patient’s blood sugar levels. The procedure can be completed at minimal charge to a patient, anywhere from $35 to $55, and at a frequency deemed necessary by the clinician. Code D0411 is generally paid by conventional dental plans but should be considered for possible medical reimbursement. The proper protocols, including appropriate referrals to primary care, can aid in the diagnosis of prediabetes and diabetes.

Incorporating any new procedure into daily practice can seem daunting. A quote attributed to Nelson Mandela says it best: “It always seems impossible, until it is done.” With the proper education, understanding, and protocols, screening can become a routine part of your patients’ experiences.

Author’s note: Before incorporating glucose screening into your patient protocol, it is crucial to contact your state dental board to determine state-specific laws and certifications.

Reference

1. Centers for Disease Control and Prevention. National Diabetes Statistics Report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Published 2017. Accessed March 28, 2018.