We are wanting to obtain baseline charting on all patients. When do you and or the ADA recommend this to be done (at what age)? Also, when does this become a D0180..if they have 4's and or signs such as smoking and/or diabetes?
Karen, this is a good question for which the correct answer involves clinical judgment per case. The ADA does not give a specific age-related recommendation for full-mouth charting. In some cases you may have a 12 year old with a full dentition and signs of gingival inflammation in which a full periodontal charting should be performed, and in other cases a 12 year old may present with a mixed dentition with little or no gingival inflammation. As a practice guideline, what I recommend, is within two years of presenting with a full dentition, patients should have baseline periodontal charting recorded, unless evidence of gingival inflammation presents sooner. For some, this may be 11 years old and for others it could be 16. Clinical judgment is the key but you do need to establish your own practice guideline for baseline charting. The AAP recommends annual periodontal charting/evaluation on all adult patients. Legal age considered for adulthood would be 18, but in many cases waiting until that age for the first periodontal chart to be recorded, a clinician will find themselves overlooking / documenting active infection.
Regarding D0180, again clinical judgment is required. D00180 can be performed on both new and existing patients, and even though often used in specialty periodontal practices; can also be used in general practices. The reason D0180 exists is to reflect that extra time and expertise is required to comprehensively evaluate the periodontal condition due to clinical evidence and risk factors. In many cases an annual periodontal charting on healthy or periodontally stable patients is included with the Periodic Exam D0120 description, and billed accordingly. The reimbursement for D0180 is HIGHLY variable for payors. In some cases even when reported, it will be reimbursed only at the D0120 amount which is generally a lower fee due to less time involved for data collection. In some cases it may have a “once in a life-time” benefit; or a benefit payable only every 3 years. You would not report the D0150 Comprehensive Oral Evaluation and D0180 on the same date, but rather select one based upon the definitions of the codes for the new or existing patient. You may report D0180 on the same date as the D4910 Periodontal Maintenance, even though payors may convert the benefit to the D1020. I just think it is important for practices to realize the reality regarding how insurance payors reimburse for this code, even though the patient needs what the patient needs!
There is no specific guideline given to dentists or dental hygienists about when to use the D0180 in practice, but I can offer some considerations for implementation. Upon the first new patient visit to the office either D1050 or D0180 should be used. If D0180 is used initially, you will most likely want to perform an annual D0180 on these patients following any periodontal therapy and it could be included during the D4910 periodontal maintenance. If, during the course of care on existing patients the clinician needs more time to perform a comprehensive periodontal evaluation either to diagnose the condition accurately or to monitor the periodontal status, the patients can be re-scheduled with the dental hygienist for D0180 to collect all data, and the dentist can confirm the diagnosis and treatment plan. I have seen some practices alternate D0120 w/o recording comprehensive periodontal evaluations with D0180 when it is all documented for all periodontal maintenance patients; but again, reimbursement for this code is highly variable. I suggest that all of the dental hygienists and dentists in your practice discuss your own parameters of how you wish to take advantage of using this code on your patients since there is not a hard/fast rule that applies to every situation.