by Dianne Glasscoe Waterson, RDH, BS, MBA
Do you have any information on when it is appropriate to use the code D0180 Comprehensive Periodontal Evaluation? Is this for a new or established patient? Is it just for periodontal offices? In our office we currently just use the code 183 for periodontal charting for new and established patients. Things that I have read about the code D0180 seem kind of fuzzy, and I'm not clear as to when, if ever, to use this code.
Currently, there are six different exam codes that are available. Most hygienists are familiar with the D0120 code, which is the code for Periodic Oral Examination – Established Patient. However, my experience is that many offices seem unaware of the D0180 code. Let's examine the strict definition of each code as set forth by the ADA Current Dental Terminology.
D0120 Periodic Oral Evaluation – Established Patient: "An evaluation performed on a patient of record to determine any changes in the patient's dental and medical health status since a previous comprehensive or periodic evaluation. This includes an oral cancer evaluation and periodontal screening, where indicated, and may require interpretation of information acquired through additional diagnostic procedures."
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Notice that this code is for the established patient and also includes the oral cancer evaluation and periodontal screening. A screening is different than a full-mouth periodontal probing and charting. Some offices use the screening tool PSR (Periodontal Screening and Recording) in conjunction with the D0120 code.
D0180 Comprehensive Periodontal Evaluation – New or Established Patient: "This procedure is indicated for patients showing signs or symptoms of periodontal disease and for patients with risk factors such as smoking or diabetes. It includes evaluation of periodontal conditions, probing and charting, evaluation and recording of the patient's dental and medical history and general health assessment. It may include the evaluation and recording of dental caries, missing or unerupted teeth, restorations, occlusal relationships and oral cancer evaluation."
According to the code description, this code can be used for either a new or established patient. If a new patient has signs or symptoms of periodontal disease, it may be preferable to use this code rather than D0150 (Comprehensive Oral Evaluation), as the D0180 includes all elements of a comprehensive restorative and periodontal exam. It would be inappropriate to report both D0150 and D0180 on the same visit. It would not be appropriate to use D0180 if only a PSR is performed, as PSR is a component of the D0120 exam. Also, if the patient has risk factors such as smoking or diabetes, it is appropriate to use D0180. (According to the National Institutes of Health, smoking and/or diabetes are the two primary risk factors for periodontal disease.) The D0180 code can be used in general or periodontal offices, as it is not specialty specific.
The rationale for using the D0180 code is that the comprehensive periodontal evaluation is an additional component that is not covered under D0120. Most offices attach a higher fee to D0180 because of the extra time needed to conduct a full-mouth, six-point probing and recording for all teeth plus charting of recession, mobility, exudate, etc.
Some offices use two fee levels for D0180: a higher fee for new patients to reflect the additional time needed, and a lower fee for the established patient needing a periodontal evaluation. The D0180 code can be used on established patients who have risk factors and require a comprehensive periodontal evaluation. Many offices alternate between D0120 for the garden-variety preventive appointment and D0180 for when a full-mouth periodontal charting is performed once a year. (Keep in mind that most third-party payers will cover two exams per year.)
One of the most frequently asked questions is whether or not third-party payers will cover D0180. The answer depends on the payer, as their practices are highly variable. According to reports from some of my client offices, some payers will reimburse D0180 once every 12 or 24 months. Some payers will downcode the D0180 code to D0120 for reimbursement. A few will reimburse this code once per lifetime. Insurance companies are free to set all kinds of restrictions on payment, no matter how ridiculous those restrictions seem to us. Just remember that restrictions on payment do not preclude the dental professional from providing care that is at or above current accepted standards of care. The current standard of care is that every adult should receive a full periodontal evaluation once per year.
We should always understand that the ground is not level between dental practices and third-party payers. Dental practices are mandated by law to be completely honest and forthright in deciding which code fits the procedure. However, third-party payers reserve the right to change the submitted code -- called "remapping" -- and reimburse a procedure at a lower level. Dr. Charles Blair's book, Coding with Confidence: The "Go To" Dental Insurance Guide, is an invaluable resource for dental practices. This manual goes into detail regarding appropriate coding and nuances of codes. It is a must-have for every dental practice.
After a patient has received definitive periodontal treatment and then moves to the maintenance phase (D4910), the typical appointment interval is three months. During the course of the year, the patient would see the doctor on alternating visits for an exam. If the hygienist performed a full-mouth probing/charting, the appropriate exam code would be D0180 to reflect that service. The succeeding alternating exam would be coded D0120 to reflect an exam without a full-mouth periodontal evaluation. It is appropriate to charge a higher fee for D0180 because it takes additional time to perform a thorough periodontal evaluation with full charting. However, there is no mandate to charge a higher fee for D0180.
You mentioned that your office uses a "183" code for charting. I'm assuming this is a fictitious code that is used to help with tracking of periodontal charting, since periodontal charting is not a billable procedure.
It is important for practices to use appropriate codes to reflect the work that has been performed. The D0180 code is the appropriate examination code to use when a comprehensive periodontal examination has been conducted. Whether or not a patient's third-party benefits cover D0180 should not be a deciding factor in the necessity of the procedure. After all, dentists rely on hygienists to identify patients' periodontal needs and guide patients toward definitive care to bring disease processes under control. The periodontal charting/recording is pivotal in the identification process.
All the best,
DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. Dianne's new book, "The Consummate Dental Hygienist: Solutions for Challenging Workplace Issues," is now available on her website. To contact her for speaking or consulting, call (301) 874-5240 or email dglass [email protected]. Visit her website at www.professionaldentalmgmt.com.
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