Coding dental examination visits correctly is crucial for proper dental billing. However, there is a lot of confusion about the right medical codes to use. The American Dental Association (ADA) recommends that people should have regular dental visits and that the frequency of these visits should be adapted by dentists based on patients’ current oral health status and health history. There are six different dental examination codes and knowing what each one indicates is necessary:
- D0120 – Periodic Oral Exam, established patient: This evaluation is done on an established patient to determine changes in dental and medical health status since a previous assessment. It includes oral cancer evaluation and periodontal screening, where indicated, and may require interpretation of information obtained from additional diagnostic procedures. A screening is distinct from a full-mouth periodontal probing and charting. Sometimes, the PSR Periodontal Screening and Recording tool in conjunction with the D0120 code.
- D0180 – Comprehensive Periodontal Evaluation – new or established patient: This code is used to report evaluation of periodontal conditions, probing and charting, evaluation and recording of new or established patients’ dental and medical history and general health assessment. Patients showing signs or symptoms of periodontal disease and patients with risk factors such as smoking or diabetes would require comprehensive periodontal evaluation. This may also include evaluation and recording of dental caries, missing or unerupted teeth, restorations, occlusal relationships and oral cancer evaluation. This code should not be used along with a comprehensive oral evaluation (D0150) by the same dentist on the same visit.
- D0150 – Comprehensive Oral Evaluation, new or established patient: This code applies when a general dentist and/or dental specialist examines the patient. It applies to: new patients, established patients who have had a significant change in health conditions or other unusual circumstances, by report, or established patients who have not had active treatment for three or more years. D0150 indicates that a diagnostic treatment plan and an extensive evaluation assessment was performed, which includes all soft tissue, hard tissue, and oral cancer screening. It may include a periodontal screening and report any soft tissue irregularities, but does not require any recording.
- D0160 – Detailed and extensive oral evaluation, problem focused by report: This code indicates extensive diagnostic and cognitive modalities based on the findings of a comprehensive oral evaluation (D0150). It indicates that integration of more extensive diagnostic modalities is needed to develop a treatment plan for a specific problem. Description and documentation of the condition requiring this type of evaluation is necessary. Examples of conditions requiring this type of evaluation include: dentofacial anomalies, complex perio-prosthetic conditions, and conditions requiring multi-disciplinary consultation.
- D0170 – Re-evaluation, limited problem focused (established patient, not post-operative visit): This code is appropriate when assessing a previously existing condition related to trauma, or a follow-up evaluation for continuing issues, but should not be used to report a post-operative visit. Documentation can be included to justify necessity.
Using the appropriate codes to report the dental exam visit is crucial to indicate the work performed and ensure proper reimbursement. In an experienced dental billing company, expert medical coders are knowledgeable about the ADA’s guidelines. Dental medical billing professionals help client practices report the dental exam correctly using the latest CDT code sets, thereby avoiding complications, inconsistencies, and other barriers to payment.