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CDT-2021 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 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.

© 2020 American Dental Association

warning
  1. Do not report D0180 in addition to the comprehensive oral evaluation (D0150) on the same service date. However, the general practitioner can always report D0180 provided the patient exhibits signs and symptoms of periodontal disease, or risk factors such as smoking or diabetes.  The dentist performs a detailed full mouth periodontal charting with six points/ tooth probing on the same evaluation date. 
  2. D0180 is not used to report a periodontal screening record (PSR) since periodontal screening, where indicated, is now specifically described as a component of periodic oral evaluation (D0120). D0180 is more detailed and includes “ six point per tooth probing (full mouth) and charting,” and also identifies furcations, wear facets, abfraction lesions, areas of mobility, bleeding on probing, areas and amounts of recession, amounts of remaining attached gingiva, etc. D0180 may be reported for both new and established patients according to the nomenclature.  See comments and limitations below.

Comments

 

     

    1. Key elements of D0180 
      • Reported when performing a comprehensive periodontal evaluation only on a "qualified" patient who shows signs and symptoms of periodontal disease, or risk factors such as smoking and diabetes.  
        • 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 all the components of a comprehensive oral evaluation (D0150) plus a complete and comprehensive periodontal charting.  
        • D0150 gives the option of periodontal screening or charting, as deemed necessary.  
        • D0180 requires complete periodontal charting, which includes, but is not necessarily limted to: six-points-per-tooth pocket depths, recessions, furcations, mobilities, bleeding points, purulent discharge, minimal attachments, (i.e., amount of remaining attached gingiva) and a periodontal diagnosis.
    2. The comprehensive periodontal evaluation (D0180) may be reported for new or established periodontal patients presenting with signs, symptoms, and risk factors (such as smoking or diabetes) of periodontal disease.
    3. The comprehensive periodontal evaluation (D0180) is not specialty-specific. The general practitioner can always report it, as with any CDT code. However, the general practitioner would generally report more of the comprehensive, extensive, and all-encompassing comprehensive oral evaluations (D0150) for most new patients. D0180 may be reported for the qualified periodontal patient and the Maximum Plan Allowance (MPA) may be higher for it than for D0150.
    4. The comprehensive periodontal evaluation (D0180) is indicated for patients showing signs/symptoms of periodontal disease, or for patients with risk factors such as smoking or diabetes. If evident, list these signs/symptoms and/or risk factors in the patient chart. Reporting the D0180 code indicates that extra time and effort were spent in making an in-depth evaluation of the overall periodontal condition, including charting and “full mouth” probing. D0180 may be reported either for the initial (comprehensive) new patient evaluation or for the recall visit. However, D0180 is typically subject to the “two evaluations per year/12 months” or “one per six months” limitation. Some payers will reimburse a third evaluation, if the evaluation occurs in a different office or with a specialist. Some payers will “downcode” D0180 or “remap” it to the D0150 or D0120 lower fee for reimbursement.

Limitations

 
    1. D0180 may be reported for the established periodontal patient or patient with periodontal risk factors and requires that a full, complete, and detailed periodontal evaluation be completed. Reimbursement for D0180 is typically remapped and limited by many payers to the D0120 lower fee for established patients seen at the periodontal recall visit.
    2. Some general practice and periodontal offices establish two consistent fee levels for D0180. The higher fee is charged for the new patient comprehensive periodontal evaluation (taking more time). A lower fee is charged for the established patient’s annual periodontal oral evaluation at the periodontal maintenance (D4910) visit. Some offices alternate the D0120 and D0180 oral evaluations each six months to differentiate the more extensive periodontal evaluation performed once per year. D0180 reported at the perio recall visit may be remapped and limited by some payers to the lower fee D0120 as reimbursed for established patients. 
    3. Some payers reimburse D0180 every 12 or 24 months, others every three to five years, and some once in a “lifetime.” Reimbursement for D0180 varies widely. D0180 may be reimbursed only “once” per lifetime (like D0150) per doctor or billing entity by a few payers. 
    4. D0180 may be reported on the same service date as active periodontal maintenance therapy (D4910), but is subject to the “one per six months” or “two evaluations per year/12 months” limitation. In some cases, reimbursement will be made at the lower D0120 fee. Some plans occasionally reimburse at a higher fee. Some offices perform a detailed and extensive annual evaluation on the established periodontal patient and report the more extensive D0180 once per year. D0180 encompasses all elements of the comprehensive periodontal evaluation and must include mandatory full mouth probing with extensive periodontal charting and a comprehensive periodontal evaluation by the dentist.
    5. D0180 is prohibited to be billed on the same service date as full mouth debridement to enable a comprehensive oral evaluation (D4355).  D4355 enables D0180 to be performed (after a healing period) on a subsequent date for these patients with signs and symptoms of periodontal disease.

Narratives

 

    List the patient’s sign(s) or symptom(s) of periodontal disease and/or risk factors (e.g., smoking or diabetes) in the patient’s chart. Generally, a narrative on the claim form is not required.

 

D6980

REVISED CODE

Fixed Partial Denture Repair

A single cast metal crown restoration that is retained, supported and stablized by an abutment on an implant; may be screw retained or cemented.

NOTE: May be orthodontic related