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Comprehensive Periodontal Evaluation Code

Ask the Expert ForumCategory: Insurance CodingComprehensive Periodontal Evaluation Code
guestuser asked 11 years ago

Our office is at odds on how to use the comprehensive periodontal evaluation code. One thought is yearly as we were told by a consultant it can be used and covered at that interval so we are under using it. The other thought is when perio is diagnosed and when a patient has been non-compliant and conditions are not stable or when they have changed. What is the most common way this is used?

1 Answers
Karen Davis, RDH, BSDH answered 6 years ago
I cannot answer which is the most “common” method practices are utilizing the D1080 Comprehensive Periodontal Evaluation, but I can advise you on the indications and common limitations of this code. This code is not to be used if a PRS or limited periodontal screening is performed, as that falls into the description of the D0120 Periodic Oral Exam. When D0180 is used it requires a 6-point probing and charting, identification of wear facets, abfractions, mobility, bleeding sites, recession, furcations, minimal attached gingiva, etc. It is just as the word describes: comprehensive, and it can be performed on new or existing patients. The indications would be for a patient who presents with risk factors such as tobacco use or diabetes or progressing periodontal conditions, or for a past-due periodontal patient when more time is required to assess and diagnose their case. Reimbursement is hugely varied per plan. Some plans will “downgrade” the D0180 to a D0120 and pay the lower amount. Some reimburse D0180 every 12 or 24 months, others every 3-5 years and even some “once in a lifetime”. Some practices have a higher fee structure they bill for D0180 on a new patient when more time is required and a lower fee structure for D0180 for periodontal maintenance patients annually; but in both cases the description of the procedures performed, as noted above, should be the same. Each practice will have to determine how they wish to use this code; but it is not a code that routinely gets reimbursed annually by all plans, so just be aware of that. Good question. I actually think the D0180 is underutilized in many practices and is a great option when more time is needed to collect data and formulate an accurate diagnosis and treatment plan for patients with periodontal disease.

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