Maximize dental exam insurance reimbursements
There is often confusion about when and what code to report to insurance companies for a patient’s examination visit. This easy-to-follow list should help with this sometimes challenging responsibility.
There is often confusion about when and what code to report to insurance companies for a patient’s examination visit.
Frequently used examination codes – CDT2015
D0120 – Periodic Oral Evaluation – established patient
This code should only be used to report that a diagnostic treatment plan and evaluation assessment was performed on a patient to determine any changes since the patient’s last visit. This code is to be billed for established patients only.
D0140 – Limited Oral Evaluation – problem-focused
This code applies to patients who enter your practice with a specific condition such as an emergency, infection, or something similar. The key words here are problem-focused, so it should be billed only for patients with focused problems, not periodic evaluations.
D0145 – Oral Evaluation for patients under three years of age – and counseling with their primary caregivers
This code applies to children under the age of three, typically during or after the exposure of their first primary tooth. This code also reports that a full diagnostic treatment plan and evaluation assessment was performed on the child.
D0150 – Comprehensive Oral Evaluation – new or established patient
This code applies when a general dentist or dental specialist evaluates the patient. Not only is a diagnostic treatment plan and extensive evaluation assessment performed, this should also include all soft tissue, hard tissue, and oral cancer screenings.
D0160 – Detailed and extensive oral evaluation – problem focused, by report
This code applies when a patient has previously presented for an exam (D0150) and/or a periodontal exam (D0180). It indicates that the patient requires a much more extensive exam due to the condition assessed on their previous exam.
D0170 – Re-evaluation – limited problem-focused, established patient, not post-operative visit
This code applies when assessing a previously existing condition. This is related to trauma or follow-up evaluation for continuing issues. This code should not be used to report a postoperative visit. An accompanied narrative can justify the reason for necessity.
Keep in mind that insurance companies have limitations, such as “two per year” or “one per six months.” Very few companies allow for three examinations, and this is always dependent upon narratives you provide to the insurance company to justify the reasons for necessity. As always, make sure you refer to the most current CDT code sets to avoid complications and discrepancies.
Kyle Summerford is the new editorial director for Dental Assisting Digest. He has been in various positions in the dental field for over 13 years, has published in various dental publications including Dental Economics, and owns Summerford Solutions Inc. dental management consulting company.