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.
Can the D0170 be charged out 30 days after srp to evaluate after tx?
Hi April, one of our dental billing experts says, “It can, but it shares frequency with all other exam codes and many plans don’t cover the code.”