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D0120 Billing Question

Ask the Expert ForumCategory: Insurance CodingD0120 Billing Question
guestuser asked 10 years ago
I work in private practice and school based health services in CT. In school based we perform prophylaxis, fluoride, sealants and x-rays. Even though we are charting clinical findings, we are not allowed to bill for a "periodic oral exam" because there is no doctor with us. I have had hygienists raise the question time and again if it is legal for a private office to bill out for a periodic exam D0120 if the doctor did not physically see the patient. Can a D0120 be billed at that appointment? Or what if the patient is then rescheduled with the doctor at no charge because something may have been found and they need to examine the patient themselves? Does that legitimize the billing of that code with the hygienist earlier?
2 Answers
Karen Davis, RDH, BSDH answered 6 years ago
This is a good question and I understand the scenario you are describing lends itself to want to be able to bill for all services provided irrespective of who provided them; however, the D0120 Periodic Exam can only be billed or submitted to insurance if the dentist examined the patient and made a diagnosis. While the dentist can delegate collection of data and dental hygienists certainly make assessments and even recommendations; unless state law enables a dental hygienist to make a diagnosis, the diagnostic code for Periodic Exam cannot be utilized. So, even if the dental hygienist performs all assessments listed under the description of Periodic Exam and the patient returns on a different date to see the dentist to confirm findings; only at that time can the Periodic Exam be billed.
sofia answered 5 months ago
In most cases, billing for a D0120 Periodic Oral Evaluation typically requires direct involvement or oversight by a dentist. However, regulations and policies may vary by state and insurance carrier. It's essential to review the specific guidelines provided by your state's dental board and the terms outlined by the insurance companies you work with. If the patient is rescheduled to see the dentist following the initial appointment with the hygienist, and the dentist performs a comprehensive evaluation, this may justify billing for the D0120 code. However, it's crucial to ensure that the documentation supports the necessity and appropriateness of billing for this code. For more information on Periodic Oral Evaluation (D0120) and its billing guidelines, you can visit Periodic Oral Evaluation (D0120).

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