Is D0170 covered by insurance?

Coverage for D0170 varies by insurance provider. It is important to verify with the patient's insurance plan for specific coverage details.

How often can D0170 be billed?

The frequency of billing D0170 depends on the patient's condition and insurance policy. Ensure that the necessity for re-evaluation is well-documented.

What is the difference between D0170 and D0120?

D0170 is used for re-evaluating specific conditions, while D0120 is for periodic oral evaluations of overall oral health.

What should be included in the documentation for D0170?

Documentation should include the patient's initial condition, reason for re-evaluation, clinical findings, and any changes in treatment.

D0170

Re-evaluation - Limited, Problem Focused - CDT Code Guide

Diagnostic/Clinical Oral Evaluations

Overview

CDT Code D0170 is used for re-evaluating the status of a previously identified dental condition in an established patient. This code is applicable when a patient requires follow-up monitoring after an initial treatment, such as in cases of traumatic injury or undiagnosed persistent pain. It is not used for post-operative visits but rather for assessing ongoing issues that need further evaluation. Dental professionals use this code to ensure that conditions like soft tissue lesions or other unresolved dental problems are monitored appropriately over time, ensuring optimal patient care and outcomes.

When to Use This Code

Follow-up evaluation for a traumatic dental injury after initial treatment.
Monitoring a soft tissue lesion that requires further assessment.
Re-evaluation of persistent, undiagnosed pain that was previously addressed.
Assessing the healing progress of an oral condition that was treated in a prior visit.
Evaluating the effectiveness of a treatment plan for a chronic dental issue.

Documentation Requirements

Detailed notes on the patient's initial condition and treatment provided.
Clear documentation of the reason for the re-evaluation visit.
Clinical findings and observations during the re-evaluation.
Any changes in the patient's condition or treatment plan.
Patient's response to previous treatments and any new recommendations.
Date and signature of the dental professional conducting the evaluation.

Billing Considerations

D0170 is typically used when a patient returns for a follow-up visit that is not related to post-operative care. It is important to document the necessity of the re-evaluation clearly. Frequency limitations may apply, and it is advisable to check with the patient's insurance for coverage details. Common modifiers may include those indicating a distinct procedural service.

Related CDT Codes

D0150 D0180 D0120 D0140 D0191

Frequently Asked Questions

No, D0170 is not intended for post-operative visits. It is used for re-evaluating existing conditions that require further monitoring.

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