D0170 Limited, Problem Focused (Established Patient, not a post-operative visit)

Coding Tip: D0170 Limited, Problem Focused (Established Patient, not a post-operative visit)

“Code what you do” is the mantra for filing of dental claims; however confusion over which codes to use is where we sometimes lose our way

D0170 is used when the dentist is “assessing the status of a previously existing condition” This code is stand-alone (can be paid without any other procedures) but is not to be used in the assessment of a new patient or for a post-operative procedure. There must be a previously billed evaluation code for the patient that identified the condition for which the patient needs a follow-up visit.  The codes that would proceed D0170 are D0150, Comprehensive Oral Evaluation; D0180 Comprehensive Periodontal Evaluation or D0140, the Problem Focused limited oral evaluation and lastly the D0120, the Periodic Oral Evaluation

Most plans have limitations on the number of collective evaluations a year, but many, especially during the pandemic, have allowed an extra code for assessments such as D0170, where follow-up is necessary for the patient’s well-being.

For instance, the patient, a ten-year-old boy, suffers a facial trauma when hit in the mouth by a flying skateboard. He is an existing patient of record.  There are a soft tissue lesion and a small fracture of the anterior #8 incisal.  The patient is required to be reassessed to see that the tooth doesn’t die, and the lesion heals.  The patient initial evaluation code for a visit is D0140, Problem-focused.   Because no treatment was performed on this visit (it is not post-operative), the follow-up code will be the D0170 Limited Problem-focused evaluation.  Radiographs taken during this visit will apply to the evidence of necessity (narrative).

Narrative:  Previously evaluated tooth #8 on ______________(date) necessitated a more thorough evaluation due to fracture of #8 and soft tissue lesion above #8,9.  Radiograph necessary to assess fracture or other damage to the anterior teeth #8,9.