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Comprehensive Periodontal Evaluation Code

Ask the Expert ForumCategory: Insurance CodingComprehensive Periodontal Evaluation Code
Avatarguestuser Staff asked 5 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, BSDHKaren Davis, RDH, BSDH Staff answered 11 months 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.