Detailed Oral Evaluation - CDT Code Guide
Overview
CDT code D0160 is designated for a detailed and extensive oral evaluation that is problem-focused. This procedure is typically used when a patient presents with complex dental issues that require a thorough diagnostic approach. Unlike routine evaluations, D0160 involves extensive diagnostic and cognitive modalities to address specific dental problems. This evaluation is crucial for developing a comprehensive treatment plan, especially in cases involving dentofacial anomalies, complex temporomandibular dysfunction, or conditions that necessitate multi-disciplinary consultation. Dental professionals use this code when a patient's condition is beyond the scope of a standard oral evaluation, ensuring that all aspects of the patient's oral health are considered in the treatment planning process.
When to Use This Code
- Patients with dentofacial anomalies requiring detailed assessment
- Cases involving complex temporomandibular dysfunction
- Patients presenting with facial pain of unknown origin
- Conditions requiring multi-disciplinary consultation
- Complicated perio-prosthetic conditions needing thorough evaluation
Documentation Requirements
- Detailed description of the patient's condition
- Comprehensive diagnostic findings
- Rationale for the use of extensive diagnostic modalities
- Documentation of the treatment plan developed
- Reports from any multi-disciplinary consultations
- Patient's medical and dental history relevant to the condition
Billing Considerations
When billing for D0160, it's important to note that this code is typically used for complex cases and may not be covered as frequently as standard evaluations. Insurance providers may require detailed documentation to justify the necessity of this evaluation. Be aware of any frequency limitations imposed by the patient's insurance plan. Common modifiers may include those indicating the complexity of the case or the need for additional consultations.
Related CDT Codes
Frequently Asked Questions
D0160 should be used when a patient presents with complex dental conditions that require a more detailed and extensive evaluation than a standard oral exam.
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