D0140: Limited Oral Evaluation – Problem Focused
Many dental practitioners are concerned about dental codes and their ability to appropriately classify various procedures for insurance purposes. It is critical to use the correct dental codes, but this can be hard; this is why most dentists choose DentalRevu to streamline their backend processes.
The D0140 dental code – problem focused is used to evaluate a single issue or complaint (emergency). Additionally, specialists may also report D0140. A periodontist may record this assessment code in conjunction with crown lengthening, bone grafting, or frenectomy.
D0140 may be reported by an endodontist in conjunction with a root canal examination. Specialists may also submit a consultation report (D9310) in lieu of the D0140. D0140 is used and reimbursed in a widely variable manner in these situations.
When a person is not a patient of record, some offices charge for D0140 in conjunction with an extraction since the new emergency patient requires additional time and effort to process and set up a chart. With this in mind, office policies and procedures should be similar for insured and uninsured individuals.
What are the Warnings of the D0140 Dental Code?
- Consider D0140 for new patient evaluations when a self-referred patient seeks a second opinion on a specific condition. Consider performing a D0150/D0180 oral examination if the self-referred patient has received a thorough treatment plan from another dentist and is seeking a second opinion.
- Reporting a single bitewing (BW) image obtained during the D0140 appointment may result in the yearly “once a year” BWX quota being exhausted. Diagnostic pictures exposed during an emergency evaluation are normally excluded from the annual BWX limits. PAs are considered distinct and self-contained procedures.
- If a Full Mouth Series (FMX) or if multiple PAs are taken during the plan’s restriction period, or several periapical films are exposed on the same service date, a deductible and a maximum charge limitation may apply.
- Consultations (diagnostic services provided by a dentist or physician following a referral from another dentist or physician) D9310 should not be reported for patients who self-refer for a second opinion. D9310 may be subject to the “two evaluations per year” limitation if insurance is provided..
- D9310 is considered for reimbursement by some payers on a case-by-case basis. Recommendations to specialists may be seen more favorably by payers than referrals to another general dentist. It is reported by a dentist when delivering clinical care to a patient who has been referred expressly by another dentist or physician.
- Consider D0140 for new patient evaluations when a self-referred patient wants a second opinion on a problem-focused complaint. If the self-referred patient has been given a full treatment plan by another dentist and wants a second opinion, consider a D0150/D0180 oral evaluation.
- Case presentation (D9450) should not be reported for the initial examination of self-referred patients. Instead, submit D9450 for case presentations on a date after the patient’s thorough oral evaluation (D0150/D0180) service date.
- Some doctors do a little treatment during an emergency visit but incorrectly describe it as an issue focused restricted oral evaluation (D0140). D0140 is a code for an oral evaluation, not a therapy code. D9110 may be recorded if a small procedure was performed owing to pain, sensitivity, or discomfort (for further information, see palliative (D9110).
- D9110 and D0140 are frequently not paid if reported on the same service date. Similarly, if reported on the same service date as definitive treatment, the problem focused oral evaluation (D0140) may be rejected.
- Some practises do not employ D0140, instead reserving the evaluation allowance for the full oral evaluation (D0150/D0180) or periodic oral evaluation (D0120) visit. The fact that the D0150 and D0180 have a higher UCR (usual, customary, and reasonable) fee occasionally influences this billing/coding decision.
- However, D0140 is a stand-alone code that can be recorded alongside any other treatment procedures performed on the same service date, such as palliative, extraction, or filling (D9110), but keep in mind that reimbursement is subject to the plan’s limitations.
What are the Limitations of the D0140 Dental Code?
- Many payers limit evaluations of any kind to “one evaluation every six months” or “two evaluations every year/12 months.” or This type of evaluation (D0140) is frequently denied since it is a “additional” evaluation. This general norm is not without exceptions.
- Along with the two annual periodic oral evaluation appointments, certain payers will fund a problem focused evaluation (D0140) or examination with a specialist. Furthermore, some plans permit up to three restricted oral examinations each year.
- Some plans do not have any frequency restrictions. In addition to the standard “two oral examinations per year,” a consultation (D9310) is sometimes covered for a visit to a specialist. As a result, D0140 or D9310 reimbursement is quite variable.
- Some payers will not cover D0140 if it is performed concurrently with a definitive procedure (e.g., extractions, fillings, etc.) on the same service day. Extraction and periapical diagnostic pictures, for example, are frequently paid, whereas D0140 conducted on the same service day may be rejected.
- D0140, on the other hand, is a stand-alone code that can always be charged in addition to the therapeutic operation delivered. If the clinician is out-of-network, the patient will be forced to pay for the D0140 assessment out of pocket.
Additional Information about the D0140 Dental Code
- Palliative (D9110) and periapical diagnostic imaging (D0220/D0230) work together for emergency evaluations when a minor (not definitive) operation is involved. In contrast, even a single bitewing image reported/billed at a problem focused examination (D0140) or emergency visit may count toward the standard “one per year” BWX limitation. For more information, see D0270/D0272/D0273/D0274. Nonetheless, always report what you do; never modify a code for the purpose of reporting or gaining a greater payment.
- Pulp vitality examination (D0460) is a self-contained code. The UCR charge for D0460 is frequently slightly cheaper than the fee for D0140. Certain payers restrict coverage to D0140 or pulp vitality testing (D0460) performed on the same service day. When the “two evaluations per year” cap is reached, D0460 may be reimbursed “stand-alone.” See D0460 for additional information on reporting this code “stand-alone” during an emergency visit.
- Consider restricting the use of problem-focused restricted oral evaluations (D0140), which frequently count toward the “one evaluation every six months” or “two evaluations every year/12 months” constraint. Consider reporting palliative treatment of dental discomfort (D9110) in lieu of any required periapical radiography pictures when a modest procedure is performed to alleviate the pain. D9110 contains comments on the proper use of the palliative code. While D0140 can always be reported in conjunction with D9110, payers frequently impose payment restrictions on D0140.
- Diagnostic procedures distinct from and in addition to D0140 may be recorded. Radiographs and viral cultures (D0416) are two instances of independently reported services. Additional procedures must be judged required by the physician for the purpose of evaluating the individual problem/complaint and must be accompanied by a narrative.