D0120 Billing Question

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.

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).