Everything You Need to Know About Each Dental Code dental code dental codes dental coding dental hygiene codes

The 800 page Complete Coding Resource Manual is the front desks personal security blanket. Obviously, with 800+ pages there is a wealth of information. This is the compiled wisdom of Dr Webb's years of experience with coding. In fact, it started out as his own office manual. It is now the foundation of your coding resources.  Here's a list of some of the major areas: How to communicate with the patient. Which would YOU buy most readily - a prophylactic (condom) or did you say prophylaxis? - or clean breath and sparkling teeth? See, it matters. How the ADA describes it. What will Delta Dental do with it? If it's denied you can charge the patient and if its disallowed, you can't. Do you know which codes are denied versus disallowed? Coding advice, short-cuts, alternatives, warnings, suggestions. If a chart or form is very often involved, it likely is the next page in the book, behind the code number that it references. Can this code be billed to medical? ...and a lot more...

800+ Pages - Everything you want to know about any code. Includes many forms and needed narratives.  The Complete Coding Resource Manual is just that - everything you would want to know about each code for submission to the insurance company. It is fast, convenient and complete.   Separately                                              $299 Get the Complete Combo - everything - for about the same as this 800 page coding resource and the UCR table. Spend more of your time relaxing instead of searching for  insurance code information $ 699.99     You Save! $ 436       Call Now! 1.877.628.3366

Are You Underreporting and Undercharging Your Most Critical Procedures?

        That’s too bad; they’re paid by insurance at 100% of UCR.

Most dentists have a preoccupation with the technical aspects of their professional day and an aversion to the daily management of the business. That’s easily explained; you are highly trained in clinical matters, and probably very much less trained in dental insurance and financial matters. So you delegate the front desk problems. Stephen Covey taught us that delegating without training is really just dumping. Statistics from the dental insurance industry show that you are losing tons of money by ignoring the issue. Evaluations, you may still be using the term “exams”, serve as a perfect example. They are paid at 100% and statistically you are still undercharging for those services.  Worse, many doctors don’t even charge, at all, for many of the evaluations they perform.

Quick Quiz

Write directly on this page the average number of times per day that you use each of these codes: D0110, D0120, D0130, D0140, D0150, D0160, D0170, and D0180. How did you do?

D0110 – what was called an initial exam, is no longer a valid code and isn’t payable at all.

D0120 - is so old that it’s still called a periodic “exam” while the others are now “evaluations.”

D0130 – is a trick question. It doesn’t exist in the current nomenclature.

D0140 – Limit Oral Evaluation – Problem Focused, could be used very often per day.

D0150 – Comprehensive Oral Evaluation – New/Established Patient, very usable.

D0160 – Detailed and Extensive Evaluation – Problem Focused by Report

D0170 – Re-Evaluation – Limited Problem Focused, should be used several times a day in hygiene.

D0180 – Comprehensive Periodontal Evaluation – New/Established Patient, the most underused code of all, perhaps. I’ll show you, later, why this might be the most important code on the list.

How many of these codes are actually new to you, that is, you didn’t even know that they existed? My training experience tells me that the answer is that more than one of them is completely unknown to you.

Now go back and repeat the process, this time recording your average fee for each of the codes. Remember, insurance pays 100% of the UCR on these codes. By now the problem should be clear.

So, let’s solve the problem. Actually, there are at least two problems aren’t there? Which code to use when and what fee is appropriate for each individual situation?

Before the discomfort gets to extreme for you, and you decide to delegate this article to the front desk people, let me add that the proper diagnosis is based on your evaluations. And, that the proper diagnosis is becoming a matter of litigation on a daily basis. And, that many dentists are losing their license because of a missed or non-diagnosed problem. And, many dentists are sued because of the liability associated with the non-diagnosis of dental diseases today. A current example: systemic problems, including diabetes and cardiovascular diseases, are directly impacted by concurrent periodontal diseases and their treatment. If the patient is diabetic and you fail to recognize that in conjunction with their hygiene/perio therapy, that could be grounds for serious litigation. Likewise, if one of your patients should experience a CV accident the same week you treat them in hygiene/perio; your records will likely be reviewed. Therefore, an evaluation, leading to a proper diagnosis, is perhaps the single most critical procedure that you perform daily - on a medical, legal and financial basis.  Insurance industry statistics show that many of you don’t even charge as much as the insurance policy is willing to pay. You can’t delegate this one.

So, welcome back. Let’s begin with the nomenclature: What is an evaluation? How is it different from an exam? Are we following the medical model? Why?  Why don’t we have enough codes to describe the situation? Does the nomenclature imply a specific diagnosis? What diagnostic codes do I use in dentistry? Are diagnostic codes required for documentation? When do we get to the money part? No worries, mate, I’ll make this as painless as possible.

A Peek at Medical Evaluation Coding

Coding a medical insurance claim involves several steps.  The codes for place of service range from 01 to 99. There are six physical status modifiers, P1 through P6. This describes how sick the patient is. There are books on how to code Evaluation and Management, or what we called “exams”.  E&M code numbers range from 99201 through 99499. Important to this discussion: there are separate and distinct codes for new patients, patients of record, patients seen on an emergency basis only and patients seen for consultation only. Hint: the fees are different for each of these conditions or combinations of conditions. In dentistry we have a half-a-dozen codes, for which most dentists incorrectly think they have to have the same fee, and for which a majority of dentists are actually charging less than the insurance policy would pay. This introduces the concept taught to me and many others by Dr. L.D. Pankey: if the procedure is different, with different levels of care, skill and judgment, then the fee should be different. If dentistry had more codes, dentists would be more likely to assign more (i.e. different) fees for the evaluation codes. The lack of a proper number of codes has led dentists to significantly undercharge for the few codes dentistry does have. You must seriously consider changing this in your office. It is fair to charge different patients different fees for the same code, since the care, skill and judgment involved is different. It is also legal, moral and ethical.

An evaluation is composed of:

• History
• Examination
• Medical decision making – (sinus problem or endo problem)
• Counseling
• Coordination of care
• Nature of presenting problem; and
• Time

With that many variables involved, it seems obvious that the fee will vary, and that the fee will not be insignificant. The amount of time required for each step usually is very different for a new patient as compared to a patient of record. Dentistry needs two separate codes at each level, like medicine. Until then, you might want to consider the difference in time and expertise involved.

Standard of Care and Focus

Sticking to evaluations and not even thinking about actual therapy, it is critical for practicing dentists to recognize that the standard of care for the GP is the same as the specialist. In court and before the state board of dentistry, you are legally responsible to diagnose any and all existing disease. It is malpractice to miss or ignore the cancer in the mouth, the periodontal disease around the first and second molars, the apical lesion, etc. If you see a patient for an endodontic emergency only and miss the oral cancer, are you still liable? Of course you are. So, the idea of focus becomes important, doesn’t it? Problem Focused could be a problem. If your focus is limited strictly to the chief complaint, and you ignore another significant problem without making at least a notation in your records, you might be the focus of the next problem.

In light of all this, let’s look a couple of the evaluation codes and limit our scope to hygiene/perio situations, they being the single most common.

Code D0140 – Limit Oral Evaluation – Problem Focused

The “takeaway” here is that D0140 is very descriptive of a “recall exam”. Since it is a newer code, the UCR tends to be higher than the D0120. You have just been reminded that your fees are too low, below UCR even, and that your liability is high. Seems like the perfect time to start using the D0140 code with a higher (variable?) fee.

Code D0170 Re-Evaluation – Limited Problem Focused

The D0170 is a RE-evaluation. That’s different than and evaluation. This is a follow-up exam. You spend your time, care, skill and judgment evaluating the patients progress following some therapy. Isn’t it clear that this code needs to be used frequently?

Code D0180

This code was created, in part, to give the periodontists an exam/evaluation code. Since we GPs are held to the same standard of care, and since a complete periodontal exam for all patients is now mandatory – for medical, legal, ethical and financial reasons, then this code becomes a very functional code for the GP dentist as well. Note that this includes new patients. This could be your “new patient” exam.  Does a comprehensive periodontal evaluation include examination and evaluation of existing restorations? Of course! How about evaluation of the oral soft tissue? Of course it does. How about….the point is a complete perio exam includes everything that a new patient exam would include.

Code D0180 Comprehensive Periodontal Evaluation – New/Established Patient

By now, it should be very obvious that your “exam” fees need to be reconsidered. Here is a simple test. If you submitted an exam fee to the insurance carrier, and they paid you 100% of the charged fee, what do you now know about your fee? You know that your fee is lower than the UCR! That is: lower than your neighbors are charging and lower than the policy allowance. I am not advocating that you charge more simply because you can. I am proclaiming loudly your need to be paid appropriately for your care, skill, judgment and time. At least charge enough to allow you to maintain your liability insurance policy.

The lack of appropriate codes, the lack of understanding of the current codes, the lack of doctor direct involvement in daily coding, the pressing and the proximate problems have all combined to cause you to lose a very significant amount of money. The worst part is that your patients have paid their insurance premiums, they have paid for the coverage, and then your office may have undercharged or even not charged for critical services that were rendered. These are procedures that are paid at 100%, no out of pocket expense to the patient. They’ve paid the premium and you’ve provided the service and the money is left sitting at the insurance company, only to become more profit for the insurance company.  So, here’s the call to action. Discuss the importance of the evaluations that your office does with the entire staff. Raise your fees immediately to the UCR level, at least. Consider a variable fee schedule. It is fair to charge different people different amounts for the same code: because we don’t have enough differentiating codes! Take action today.

 How will Delta Dental handle the new codes? Sounds like you need the Complete Coding Resource manual. This isn't a book you read, this is a coding book that saves your bottom when the patient or insurance company wants more information about a charged code. The re-wording of each procedure, to make it patient friendly so they will buy - doctors have paid the price of the book to get that list. It was a bargain. Together with the other kits, you have  a comprehensive yet easy-to-use set of tools that seamlessly integrate highly profitable management, communications, and coding techniques. With the Complete Combo, experienced and novice front office managers can implement these superior techniques easily, quickly and affordably.

The most experienced will enjoy the added power and flexibility found in one place. Skills typically learned only in multiple seminars over multiple years, at a cost of thousands of dollars and many lost office hours, will be learned quickly with this system.