May / June 2007 Insurance Solutions Newsletter a closer look at dentistry’s evaluation codes



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May / June 2007 Insurance Solutions Newsletter
A CLOSER LOOK AT DENTISTRY’S EVALUATION CODES

Evaluation codes are the most frequently performed services in dentistry. With the introduction of D0145 in CDT 2007-2008, we now have seven evaluation codes, which can be billed by any dentist, regardless of specialty. Let’s take a closer look at dentistry’s evaluation codes.


1. D0120 Periodic oral evaluation - established patient only

An evaluation performed on a patient of record to determine any changes in the patient’s dental and medical 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 diagnostic procedures. Report additional diagnostic procedures separately.


Key Elements of D0120:

  • Can only be performed on established patients

  • New patients, regardless of age, require a comprehensive evaluation

  • (D0150)--fees can be adjusted for new children (if you choose), but D0120 is only billed for established patients.

  • Includes evaluating any changes to the patient’s dental and medical

  • status since a previous comprehensive or periodic evaluation

  • Includes an oral cancer evaluation

  • The oral cancer screening and diagnosis must be documented

  • Includes a periodontal screening (e.g., PSR or six-points-per tooth periodontal probing and charting), where indicated. Some patients may not require a periodontal screening (e.g.,

  • young children or edentulous patients)

Does the dentist have to actually examine the patient in order to bill D0120?

Yes, an evaluation code currently requires clinical contact by a licensed dentist. Each state identifies which procedures can be performed by a licensed dentist or hygienist in that particular state. However, CDT 2007/2008, as published by the American Dental Association, identifies the conditions for reporting those procedures. So, while a hygienist may be allowed to perform an evaluation in certain states, currently there is no code to report an evaluation performed by a hygienist.
In fact, the Code Revision Committee (CRC) recently denied a request for a “non-clinical periodic oral evaluation” code stating,“...A periodic oral evaluation requires a dental diagnosis, including clinical contact, by the licensed dentist or physician.” This CRC statement makes it clear that there is no CDT code for a “records-only” or a “hygienist-only” evaluation, at least for now.
2. D0140 Limited oral evaluation - problem focused (new or existing patient)

An evaluation limited to a specific oral health problem or complaint.

This may require interpretation of information acquired through additional diagnostic procedures. Report additional diagnostic procedures separately. Definitive procedures may be required on the same date as the evaluation.
Typically, patients receiving this type of evaluation present with a specific problem and/or dental emergencies, trauma, acute infections, etc.
Key Elements of D0140:

Evaluation is limited to a specific oral health problem/complaint

Typically used when evaluating a “dental emergency”

Document findings/diagnosis in the patient’s chart--do not use D0140 if the problem was diagnosed during a previous exam.

May be performed on new or established patients
Additional diagnostic procedures should be reported separately Radiographs, pulp vitality tests (D0460), viral cultures (D0416), etc., may be reported separately when required to evaluate the specific problem/complaint

Definitive procedures may be reported on the same date


3. D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver

Diagnostic and preventive services performed for a child under the age of three, preferably within the first six months of the eruption of the first tooth, including recording the oral and physical health history, evaluation of caries susceptibility, development of an appropriate preventive oral health regimen and communication with and counseling of the child’s parent, legal guardian and/or primary caregiver.


Key Elements of D0145:

  • Goal is early intervention/development of a prevention plan

  • Performed on patients under three years of age

  • Includes both diagnostic and preventive services

  • Recording the oral and physical health history

  • Evaluation of caries susceptibility (risk assessment)

  • Includes counseling with the child’s primary caregiver

  • Instructions for cleaning child’s teeth

  • Fluoride recommendations

  • Diet recommendations

  • Recommendations to reduce transmission of bacteria

(e.g., antibacterial rinses, xylitol, saliva substitutes, etc.)

4. D0150 Comprehensive oral evaluation-new or established patient

Used by a general dentist and/or specialist when evaluating a patient comprehensively. This 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 been



absent from active treatment for three or more years. It is a thorough evaluation and recording of the extraoral and intraoral hard and soft tissues. It may require interpretation of information acquired through additional diagnostic procedures.
Additional diagnostic procedures should be reported separately.

This includes an evaluation for oral cancer where indicated, the evaluation and recording of the patient’s dental and medical history, and a general health assessment. It may include the evaluation and recording of dental caries, missing or unerupted teeth, restorations, existing prostheses, occlusal relationships, periodontal conditions (including periodontal screening and/or charting), hard and soft tissue anomalies, etc.


Key Elements of D0150:

  • Reported by any dentist when evaluating any new patient comprehensively, regardless of the dentist’s specialty.

  • Use D0150 when performing a comprehensive oral evaluation on a new child over three years of age-- fees can be changed, if necessary, but not the code

  • Reported when an established patient requires a comprehensive oral evaluation due to a significant change in health condition(s) or other unusual circumstances

  • Health changes that may warrant a comprehensive evaluation on an established patient include, but are not limited to, a new diagnosis of cancer, HIV/AIDS, diabetes, Sjogren’s disease, GERD, bulimia, epilepsy, heart disease, asthma, etc.

  • Reported when an established patient requires a comprehensive

  • evaluation because he/she has been absent from active treatment for three or more years

  • Most carriers interpret active treatment to mean that the patient has not been seen in the practice in the last three years

  • Includes evaluation and recording of the patient’s medical history and a general health assessment

  • Includes pulse and blood pressure readings, medications, allergies, previous and current medical conditions, etc.

  • May include an evaluation and recording of the patient’s dental history Assuming the patient has the following, D0150 includes recording new or recurrent dental caries, missing or unerupted teeth, existing restorations, existing prostheses, occlusal relationships, etc.

  • Typically includes a periodontal screening and/or charting Periodontal screening includes six-points-per- tooth probing “May” simply acknowledges that some patients may not require a periodontal screening or charting (e.g., young children or edentulous patients)

  • Periodontal charting includes recording six-points-per-tooth pocket depths, recessions, furcations, mobilities, bleeding points, minimal attached gingiva notations, and periodontal diagnosis

A dentist may decide a full periodontal charting is not necessary if the periodontal screening was within normal limits

A dentist may decide not to perform a full periodontal charting if he/she intends to refer the patient to a periodontist based on the results of the periodontal screening



  • Includes evaluation and recording of the extraoral and intraoral hard and soft tissues

  • Looking for hard and soft tissue abnormalities lumps, tori, etc.

  • Includes an evaluation for oral cancer, where indicated

  • Includes a visual examination using operatory lighting and palpation.

  • Enhanced screening with adjunctive screening tools (e.g.,

  • ViziLite®, VELscope®, etc.) can be billed separately using D0431

  • Additional diagnostic procedures should be reported separately Radiographs, pulp tests, caries susceptibility tests, genetic tests, viral cultures, diagnostic casts, etc., can be billed separately



5. D0160 Detailed and extensive oral evaluation - problem focused, by report

A detailed and extensive problem focused evaluation entails extensive diagnostic and cognitive modalities based on the findings of a comprehensive oral evaluation. Integration of more extensive diagnostic modalities to develop a treatment plan for a specific problem is required. The condition requiring this type of evaluation should be described and documented.

Examples of conditions requiring this type of evaluation may include dentofacial anomalies, complicated perio-prosthetic conditions, complex temporomandibular dysfunction, snoring, facial pain of unknown origin, full mouth reconstruction, conditions requiring multi-disciplinary consultations, etc.

Key Elements of D0160:


  • Involves a detailed and extensive evaluation of an oral problem previously discovered during a comprehensive oral evaluation

  • Used when a condition discovered during a prior comprehensive oral evaluation requires more extensive evaluation and development of a treatment plan (e.g., orthodontic, TMD, perio-prosthetic,implant-supported prosthetic cases, etc.)

  • Requires the use of more extensive diagnostic modalities (e.g., acephalometric film, tomographic survey, mounted occlusion analysis, diagnostic casts, etc.)

  • If the patient consultation does not occur on the same day as the evaluation, D9450 (case presentation, detailed and extensive treatment planning) can be billed separately since D0160 requires the use of more extensive diagnostic modalities, and treatment is usually performed over an extended length of time. Also note, however, many carriers do not pay for D9450.



6. D0170 Re-evaluation-limited, problem focused (established patient only ; not post-operative visit, assessing the status of a previously existing condition.


  • For example: traumatic injury where no treatment was rendered but patient needs followup

  • monitoring; evaluation for undiagnosed continuing pain; soft tissue lesion requiring follow-up evaluation

  • Involves the re-evaluation of an established patient for a specific problem in which definitive

  • treatment has not been rendered Should not be used to report a post-operative re-evaluation.

  • In other words, it should not be used when re-evaluating a patient following scaling

  • and root planing, surgical extraction, root canal, implant surgery, etc.

  • Typically used to report the

  • monitoring of soft tissue abnormalities, such as an aphthous ulcer, leukoplakia, erythroplakia, follow-up appointments to monitor/evaluate trauma to soft tissue or teeth following an accident

7. 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, diabetes, heart conditions, etc. 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.
Key Elements of D0180:

  • Reported when performing a comprehensive periodontal evaluation on a patient showing signs, symptoms, or risk factors for periodontal disease

  • May be performed on new or established patients

  • May be reported by general dentists or periodontists as all codes are available to any dentist practicing within his/her scope of license

  • Requires everything involved with a comprehensive oral evaluation (D0150) plus complete periodontal charting (both charting and probing, not one or the other) D0150 gives the option of periodontal screening OR charting (can be used instead of D0150 on new patient exam if disease is present).

  • However, D0180 requires complete periodontal charting, which includes six-points-per-tooth pocket depths, recessions, furcations, mobilities, bleeding points, purulent discharge, minimal attachments, and a periodontal diagnosis



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