Emergency dental exam code D9110 helps soothe severe pain in the tooth and surrounding tissues. That is often from fractures, injuries, or infections and is non-curative.
In contrast, bridges, crowns, or fillings address cosmetic concerns instead of pain. However, the practice has to understand that immediate dental treatment is paramount in both situations, and timely intervention can impact oral health.
Dental practitioners experience confusion when coding and documenting emergency visits using D9110, the dental code for Palliative Care. The practices must master this code for accurate reimbursement from the insurer.
The American Dental Association (ADA) provides CDT codes for dental exams to establish standard terminology for dentists that leads to definitive treatment and is also helpful in communicating procedures to insurance companies.
As per ADA, palliative care is an approach to alleviating pain without aiming to cure the condition. Palliative treatment focuses on the patient’s pain and discomfort. It is the dentist's clinical decision how to relieve the patient's pain. It does not solve the underlying condition and is incomprehensible with final restorations performed on the same tooth area in a single visit.
D9110 includes a range of treatments to assist patients in pain, and due to its vagueness, this code gets employed when no other specific dental code is applicable.
Here are some common scenarios of usage of the D9110 dental code:
All these situations address the immediate patient needs and clarify treatment coding.
Adherence to guidelines is vital when documenting services. Services under the CDT code and palliative treatment are different. Palliative treatments are hands-on, and below are a few examples for further clarity on whether using D9110 is unsuitable.
A misunderstanding leads to confusion about bill D0140 (limited exam) with palliative procedures during the same visit. The ADA accepts. The insurers have limitations or exclusions about the palliative and examination performed on the same day. Both codes require X-rays if taken on that day.
Another misconception is that restoration and palliative treatments cannot be billed on the same day. Additionally, the clinical note outlines that the restoration performed on a different tooth or area is acceptable by submitting codes with D9110 to the insurer.
A detailed narrative is optimal for quicker reimbursement as it supports the procedures during the visit. The treated area of the mouth and the tooth number with methods used and material included accurately describe the treatment. The nature of the patient's pain on a scale of 1 to 10 outlines the situation for the procedure's scope and outcome.
The dental practitioner suggests future steps to handle the patient's pain and post-visit instructions. Thorough documentation increases reimbursement opportunities and enhances the quality of patient care.
A CDT code for dental exams is a must for dentists to create an understanding that insurance companies and patients know the treatment and the payments.
Oral assessment marks the beginning of effective oral hygiene of the teeth and oral tissues using dental X-rays and diagnostic instruments to review the treatment. The goal is to accurately diagnose the health of the gums and oral tissues and identify the fit of dentures and bridges, allowing dentists to provide the best treatment options. It accelerates the billing by utilizing correct codes to receive prompt payments and comply with industry regulations.
Dental billing depends upon the correct code of dental examination, and here are six distinct CDT codes for dental exams:
D0120- Periodic oral evaluation, established patient
This examination helps assess variation in dental health from the last visit. It helps to evaluate oral cancer and periodontal screening.
D0140- Limited oral evaluation, problem-focused
This code presents specific issues, such as emergencies or infections, rather than for routine evaluations.
D0145- Oral evaluation for patients under three years of age and counseling with the primary caregiver.
D0150- Comprehensive oral evaluation for existing and new patients.
D0160- Problem-focused, detailed, and extensive oral evaluation
This code replaces D9310, which some insurers no longer accept.
D0170- Follow-up evaluation for previously existing conditions
This code is appropriate for assessing trauma-related issues or ongoing concerns but not post-visits.
The dental exam code is inappropriate for the initial step of a root canal and definitive treatments such as crown preparations, permanent fillings, extractions, and office visits for observation and regular recall visits.
