D0120 

An evaluation performed on a patient of record to determine any changes in the patient's dental and medical health status sincea previous comprehensive or periodic evaluation. This includes an oralcancern evaluation, periodontal screening where indicated and may require interpretation of informtion acquied through additional diagnostic procedures. The findings are discussed with the patient. Report additional diagnostic procedures separately. 

WARNING: 

1. It is improper to report a periodic oral evaluation (D0120) or any other evaluation unless the doctor completed the clinical evaluation (on the patient) and performed the evaluation. A hygienist can screen but nt diagnose unless specifically permitted by state law. 
2. It is improper to charge insurance patients for a periodic oral evaluation (D0120), while the evaluation is "free" for non-insured patients. Treatment and free protocols should always be identical for both insured and non-insured patients.
3. The periodic oral evaluation (D0120) code includes an oral cancer evaluation (OCE). The fact that the oral cancer evaluation was done and any significant findings should be documented in the clinical notes. 
4. D0120 is reported only for a patient of record (established patient), not a new patient. 

WATCH

1. Some offices do not report periodic oral evaluation (D0120) or the comprehensive periodontal evaluation (D0180) in conjunction with periodontal maintenance (D4910). The oral evaluation is not included in D4910. Oral evaluations may be reported in additional to D4910, periodontal maintenance, when completed. The clinician may choose to perform an oral evaluation every other visit for a three-month periodontal recare patient, twice per year, or as deemed necessary.
2. The reimbursement frequency for D0120 is almost always limited. See limitations below. 
3. Do not report a new patient child comprehensive oral evaluation (D0150) using a lower fee periodic oral evaluation (D0120). See Tip #6 below. 
4. If the child is less than three years of age, see D0145 to report an oral evaluation. Counseling (diet, fluoride, oral hygiene, etc.) with a primary caregiver is required to report D0145. D0145 is not considered a "comprehensive" oral evaluation. 

COMMENTS: The findings are discussed with patient. 

LIMITATIONS

1. D0120, as all evaluations, is typically subject to the "two evaluations per year" or "one per six months" limitation, as established by the plan document. However, some payers will reimburse for a third oral evaluation when performed in a different office if there is an additional problem focused oral evaluation during the limitation period. To control costs, some employers are choosing plans that have a "one yer evaluation per year" limitation. 
2. Periodontal maintenance (D4910) does not include any type of oral evaluation as part of the procedure. Most doctors perform and report two periodic oral evaluations (D0120) per year for both periodontal and non-periodontal patients. The comprehensive periodontal evaluation (D0180) may be also used to describe a periodontal evaluation for an established periodontal patient under certain circumstances, particularly in conjucntion with D4910. See D0180 for specific reporting requirements and patient criteria. Note that some new contracts are trending toward the global "one evaluation per year" limitation. 

TIPS

1. The periodic oral evaluation (D0120) includes "periodontal screening, where indicated." A periodontal screening may, or may not be performed at a D0120 visit. This does not mean complete periodontal probing and charting is required at each periodic oral evaluation in order to report the periodic oral evaluation code. There is no separate (stand-alone) code for full mouth periodontal probing and it is included (when performed) in all oral evaluation procedures. If a full mouth probing and charting is performed on a separate, stand-alone visit, see both D0180 and D4999 for reporting. Some patients may not require a periodontal screening (e.g., young children or dentulous patients).

2. The periodic oral evaluation (D0120) includes mandatory oral cancer evaluation by the dentist, which should always be noted in the clinical record.

3. If the need for active periodontal treatment (SRP or osseous surgery) is diagnosed at the periodic oral evaluation, a comprehensive periodontal evaluation and full probing and charting should be performed to document the necessity of treatment for SRP. This evaluation should be reported as D0180 (provided a full mouth probing and charting is performed), but the reimbursement level may be limited to the D0120 fee by payors.

4. If the doctor's productivity is suffering due to frequent interruption for hygiene check oral evaluations, consider a periodic oral evaluation (D0120) of the low-risk patient once per year, as generally permitted by state law.

5. For low-risk hygiene patients, with a clean mouth, consider extending the routine six-month prophylaxis interval to seven-nine months. This would help to open hygiene time for more productive periodontal hygiene appointments.

6. Some offices erroneously report a periodic oral evaluation (D0120) rather than a comprehensive oral evaluation performed on children who are new patients (D0150) in an effort to hold down the initial comprehensive oral evaluation fee. This is a common error. The child evaluation is simpler (quicker) and prophylaxis, fluoride, and diagnostic radiographic images are typically performed on the same service date. The total visit fee could be priced appropriately. Doctors should establish two consistent fees (adult and child) for code D0150. To distinguish between the two, use D0150A (child) and D0150B (adult), or similar coding to distinguish the fee structure within your software program. The computer software will not post the "A" or "B" code for reporting purposes on the walk-out statement or electronic claim form. With this approach, the reimbursement will be higher for the child comprehensive evaluation (D0150) while the proper code is reported. Report D0150 for ages three and up.

7. An oral evaluation (either initial or recare) for a child under three years of age must include counseling with a caregiver if reporting D0145. If the periodic oral evaluation for a child under three years of age does not include counseling with the caregiver, report D0120.

8. Additional diagnostic procedures should be reported separately. Although generally not covered by dental plans, it is considered appropriate to bill caries susceptibility tests (D0425), viral cultures (D0416), etc., separately.