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.
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