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Four Codes that are Costing You Money

As deferral of dental equipment benefits moves to PPO, reimbursement rates continue to decline, leaving many offices in the midst of escalating overheads and declining cash flows and profit margins. Correct coding is crucial to maximize reimbursement, increase cash flow, and minimize errors that can result in fines or worse. Every year, a thorough coding review is required. There are four places to start here.

Fluorocode D1208 and D1206
The fluorine codes D1203 and D1204 for fluoride treatment of children and adults are replaced by code D1208 for use in children and adults. Many of the offices reporting the old norms are likely not reimbursed for these procedures. Restrictions on fluoride varnish code D1206 have been phased out, limiting the use of highly carious patients. The D1206 is suitable for child and adult reporting and pays higher UCR than D1208.
 
D0140: Limited Oral Assessment - Problem Concentration or D9110 Palliative (Emergency) Treatment of Dental Pain
D9110 is an underutilized code. In the vast majority of cases, office code D0140 is urgently accessed to treat patients for pain or discomfort. D0140 is an evaluation code, limited to the "Evaluate Every Six Months" or "Evaluate Twice" rules. Consider reporting D9110 for minor non-deterministic surgery to reduce discomfort, sensitivity, or pain in emergency situations. D9110 is a program code that does not use one of the exam limits. This palliative code pays for a higher UCR than D0140. When reporting D9110, include the desired narrative. Palliative treatment D9110 should not be used with a clear procedure.

D0180: Comprehensive Periodontal Evaluation - New or Established Patient
For established periodontal patients, patients with signs or symptoms of periodontal disease and patients with risk factors such as smoking and diabetes may report this assessment code. D0180 requires a complete and detailed periodontal assessment, including full mouth detection and detailed charts. D0180 may be reported in the same access as D4910. However, it may be downgraded to D0120 fee. Do not report D0180 except D0150 composite assessment. D0180 usually pay UCR slightly higher than D0150.

D1352: Preventive Resin Repair Risk for Moderate to Highly Carious Patients - Permanent Teeth
D1352 is a conservative repair of active cavitary lesions in depressions or crevices that do not extend into the dentin and includes a non-carious fissure or pit that places the sealant on any radiation. Do not report this prophylactic resin repair if preparation and decay extend to dentin. See single-sided composite material D2391. If there is no active decay in the enamel, do not report this preventative repair. Sealant see D1351. Do not report D1352 as the main tooth. According to Dr. Charles Blair, some programs will pay more than twice the cost of sealants, but less than single-sided composites, and some dental instruments programs will pay for the benefits of alternative sealants.

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