One of the most common questions dental teams ask is how to use the D0180 code for comprehensive periodontal evaluations. Some practices have used this code incorrectly when a hygienist does full probing. Other practices have wavered on how to use this code versus the comprehensive exam (D0150) for new patients.
The current issue of Insurance Solutions newsletter provides a helpful and detailed explanation of how to properly code for dental exams.
The comprehensive periodontal evaluation (D0180) can be performed for new and existing patients who have been diagnosed with gum disease or patients who have signs, symptoms, or risk factors associated with gum disease.
The evaluation must be performed by the dentist. Even though the hygienist gathers a great deal of the information used for the evaluation—full periodontal charting, for example—the dentist must actually conduct the evaluation.
The D0180 differs from a comprehensive or regular exam because it is focused on periodontal issues. The American Academy of Periodontology recommends this type of exam at least yearly for patients who have gum disease or who are at risk for gum disease.
So how do you integrate the comprehensive periodontal exam with the other commonly coded exams? If a new dental patient comes to the practice with gum disease and the data gathering requirements of the comprehensive periodontal exam are met, that is the appropriate code. In addition, after the patient is treated for gum disease, the D0180 code can be used at least yearly when extensive periodontal data is once again gathered.
Otherwise, new patients typically receive a comprehensive exam (D0150). Regular exams that do not fall under the D0180 or D0150 criteria are coded as periodic exams (D0120).
It is essential that dental practices code procedures correctly. By remembering a few simple guidelines, practices can effectively use the comprehensive periodontal exam code.
Learn more about how our dental practice consulting can help your practice. Call us at 503-245-0766.
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What dental examination code should be used for a new patient that has heavy calculus and the doctor is unable to record periodontal charting?
If you have saw a patient previously but they come in with new or different insurance can you file the first Prophy Exam as Comp. ( is this legal ) since this is the first prophy with this insurance company. Thank you, Christa
If you have saw a patient previously but they come in with new or different insurance can you file the first Prophy Exam as Comp. ( is this legal ) since this is the first prophy with this insurance company. Thank you, Christa
My mom was charged a d0180 and a d0120 on the same visit. She hadn’t been to her dentist in 2 1/2 years had bad periodintis with 7, 8, 9 pockets and a tooth extraction. The charge strangely was $90 for the d0120 and only $60 for the d0180. Is this charging appropriate?
We are sorry, but we cannot comment or consult on this type of question. We recommend that you contact your mother’s dentist office for further clarification and/or check with your state’s dental board.
One more reason dental hygiene MUST become self regulating. The peridontal assessment in every office I’ve practiced in my 31 year career has been performed by a dental hygienist.