Can D0191 be billed on the same day as another diagnostic procedure?

Typically, D0191 should not be billed on the same day as a comprehensive evaluation, as it is intended for limited assessments only.

Is patient consent required for billing D0191?

Yes, obtaining patient consent is a best practice and should be documented as part of the assessment process.

Does insurance usually cover D0191?

Coverage for D0191 varies by insurance provider and plan, so it is important to verify benefits and coverage with the patient's insurer.

What should be included in the documentation for D0191?

Documentation should include clinical findings, any signs of disease or injury, patient history, and recommendations for further action or referrals.

D0191

Assessment of Patient - CDT Code Guide

Diagnostic/Pre-diagnostic Services

Overview

CDT code D0191 refers to a limited clinical inspection aimed at identifying potential signs of oral or systemic disease, malformation, or injury. This procedure is crucial for determining whether a patient needs further diagnostic evaluation or treatment. Typically, this assessment is performed when a patient presents with symptoms that require a preliminary evaluation to decide the next steps in their care. It is a vital part of preventive dentistry, helping to catch potential issues early and refer patients to specialists if necessary. Dental professionals use this code to document an initial assessment that doesn't involve a full diagnostic evaluation but rather a focused inspection to guide further action.

When to Use This Code

When a patient presents with unexplained oral pain or discomfort.
During a routine dental visit when signs of an oral disease are suspected.
When a patient has a history of systemic conditions that may affect oral health.
In cases of oral trauma to assess the need for further treatment.
When a patient requires a referral to a specialist for a suspected condition.

Documentation Requirements

Detailed notes on the clinical findings during the assessment.
Documentation of any signs of disease, malformation, or injury observed.
Record of the patient's medical and dental history relevant to the assessment.
Notes on the potential need for referral and any recommendations made.
Patient consent for the assessment procedure.
Any follow-up actions or referrals provided to the patient.

Billing Considerations

D0191 is typically billed as a standalone procedure when a limited assessment is necessary. It is important to note that this code may not be reimbursed if used in conjunction with a comprehensive evaluation on the same day. Frequency limitations may apply, and it is essential to check with the patient's insurance provider for coverage details. Common modifiers may include those indicating a separate and distinct service.

Related CDT Codes

D0150 D0180 D0120 D0140 D0210

Frequently Asked Questions

D0191 should be used when a focused assessment is needed to identify potential issues that require further diagnosis, rather than a full comprehensive evaluation.

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