This month’s FB Fallacy, we are going to look at a conversation that shows exactly why coding education is needed. Note: DentalCodeology recognizes that no one is intentionally sharing misinformation.
FB User said: I found out last week there is a code for full mouth probing.
DentalCodeology response: There no code for periodontal charting.
Some questions from a recent course participant can help.
1.) If perio charting once a year is a myth, how often should we be charting?
First, here is the link to the ADHA Standards of Clinical Dental Hygiene Practice https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf. That is part of the minimum standard required for all RDH. It states: “Full-mouth periodontal charting including the following data points reported by location, severity, quality, written description, or numerically…” It does not state frequency. It certainly doesn’t say 1/year. If perio charting is part of our diagnostic process to determine the appropriate treatment, then we need to make that determination each time we see them. As we both know, health is not static. We cannot know someone’s presenting conditions only once/year. Their presenting conditions are what they present with that day.
2.) When should D0180 be used then?
Let’s first full read the code: D0180 comprehensive periodontal evaluation – new or established patient. Definition: This procedure is indicated for patients showing signs or symptoms of periodontal disease and for patients with risk factors such as smoking or diabetes. 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. I bolded the important part. Signs, symptoms or RISK factors. In the case I used, Kelly clearly had several risk factors as well as disease factors. That is the medical necessity for the D0180 to be performed.
3.) Would you happen to know the new recommendations for periodic exams? (As far as I know periodic exams are completed 1 / yr).
There are no specific recommendations, that I know of, for a periodic evaluation. Let’s again look at that specific code. D0120 periodic oral evaluation – established patient Definition: An evaluation performed on a patient of record to determine any changes in the patient’s dental and medical health 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 additional diagnostic procedures. Report additional diagnostic procedures separately. As you can see, there is no language on frequency. What is the difference between D0180 and D0120 in what you record? Nothing. Again I highlighted the important part. We must evaluate everything and the only way we know it has been evaluated is by the documentation. If we didn’t write, we didn’t do it.
4.) If a patients has been with the office for a long time, should they have a comprehensive exam D0150 every 3 or 5 years?
So now let’s look at D0150 comprehensive oral evaluation – new or established patient Definition: Used by a general dentist and/or a 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. These are crazy long. There is some time based language but only if absent from the practice. The question more often is a the portion about change in health conditions. Again, how many people have no change at all in their health conditions? Some but not all. If they have a change, does it put them at risk for caries infections? Perio? Oral Cancer.