An evaluation limited to a specific oral health problem or complaint. This may require interpretation of information acquired through additional diagnostic procedures. Report additional diagnostic procedures separately. Definitive procedures may be required on the same date as the evaluation. Typically, receiving patients this type of evaluation present with a specific problem and or dental emergencies, trauma acute infections and etc. 

1. Limited oral evaluation - problem focused (D0140) should not be used to report a routine periodic hygiene evaluation (D0120); however, should a routine periodic oral evaluation turn into a more complex problem focused evaluation requiring additional diagnostic time, then D0140 may be reported rather than D0120. The additional time spent and specific concerns addressed should be documented in the patient record. 

2. Reporting a single bitewing (BW) image taken at the D0140 appointment may potentially exhaust the annual "once per year" BMX allowance. Periapical (PA) diagnostic images exposed at the emergency evaluation typically do not count against the annual BMX limitation. PAs are considered separate stand-alone procedures. Periapicals may have a deductible and a maximum fee limitation applied if multiple peri-apical fil,ms are exposed on the same service date or if multiple PAs or a Full Mouth Series (FMX) have been taken within the plan's limitation period. 

3. Consider D0140 for new patient evaluations when a self-referring patient requests a second opinion related to a problem focused complaint. Consider a D0150/D0180 oral evaluation if the self-referred patient has been provided a comprehensive treatment plan by another dentist and the patient is seeking a second opinion. 

4. Some doctors perform a procedure at a visit, but erroneously report this procedure as as problem focused limited oral evaluation (D0140). D0140 is an oral evaluation code, not a treatment code. If a procedure was performed due to discomfort, sensitivity, or pain as a reported by the patient, D9110 may be reported (see palliative D9110 for further details). In some cases, D9110 and D0140 may not be reimbursed if reported on the same date that definitive treatment is performed. Some practices do not use D0140 but save the evaluation allowance for the comprehensive oral evaluation (D0150/D0180) or periodic evaluation (D0120) visit. This billing/coding decision is sometimes influxe by the fact that the D0150 and D0180 have a higher UCR (usual, customary and reasonable) fee. However, D0140 is a stand-alone code and may be reported in addition to any other treatment procedures rendered on the same service date, i.e., extraction, filling, or palliative (D9110), etc., but remember the reimbursement is subject to the plan's limitations. 

COMMENTS

1. The limited oral evaluation - problem focused (D0140) may be used to evaluate one problem or complaint (emergency). Specialists may also report D0140. A periodontist could report this evaluation code for a limited evaluation in association with a crown lengthening, bone graft procedure or frenectomy. An endodontist may report D0140 in association with an evaluation for a root canal.The use of, and reimbursement for, D0140 in these examples is highly variable. 

2. Under certain circumstances involving referral from a different healthcare practitioner, consultation (D9130) may be reported instead of D0140. See D9310.

LIMITATIONS

1. Many payors limit evaluations (of any type) to "two evaluations per year/12 months" or "one per six months." This type of evaluation (D0140) is often denied as an "extra" evaluation with a special addition to the the two annual periodic oral evaluation visits per year. In addition, there are few plans that allow up to three limited oral evaluations per year. A very few plans have no frequency limitations. Sometimes a consultation (D9310) is reimbused for a visit to a specialist in additional to the typical "two oral evaluations per year". Thus, the reimbursement for D0140 or D9310 is highly variable. 

2. Some payors will not reimburse D0140 in conjunction with a definitive procedure (e.g. extractions, fillings and etc.) on the same service date For example, the extraction and periapical diagnostic images are typically reimbmursed, while D0140 performed on the same service date may be denied. However, D0140 is a stand-alone code and always may be charged in addition to the clinical procedure provided. If the doctor is out-of-network, the patient can be expected to pay out-of-pocket for the D0140 evaluation under this scenario. 

TIPS

1. Some offices charge for D0140 in conjunction with an extraction when the patient is not a patient of record as the new emergency patient requires additional time and effort to process and set up a chart. This being the case, the office policy and protocol should be consistent for both insured and non-insured patients.

2. Palliative (D9110) and periapical diagnostic images (D0220/D0230) could go hand-in-hand for emergency and other evaluations when the situation involves a non-definitive procedure. Conversely, even reporting a bitewing - single radiographic image (D0270) in conjunction with a problem focused evaluation (D0140) or any other visit may apply toward a plan's bitewing limitation and impact reimbursement for bitewings taken at a subsequent visit. See D0270/ D0272/D0273/D0274 for further details. Even so, always report what you do; never change a code for reporting purposes or just to gain higher reimbursement.

3. Pulp vitality test (D0460) is a stand-alone code. The payor's fee for D0460 is often a little less than D0140. Some payors limit the benefits to either D0140 or the pulp vitality test (D0460) reported on the same service date. When the "two evaluations per year" are exhausted, D0460 may possibly be reimbursed on a "stand-alone" basis. See D0460 for further details on reporting this code on a "stand-alone" basis at the emergency visit.

4. Consider limiting the use of problem focused limited oral evaluations (D0140) as they often count toward the "one evaluation per six months" or "two evaluations per year/12 months" limitation. Consider reporting palliative treatment of dental pain - per visit (D9110) along with any necessary periapical radiographic images (D0220/D0230) as an alternative to D0140 when a procedure is performed to relieve pain communicated by the patient. See D9110 for comments about the proper usage of the palliative code, D9110. D0140 can always be reported in conjunction with D9110; however, payors may have plan-specific limitations in place regarding the reimbursement of D0140 when performed on the same date of service by the same dentist/ dental office as D9110.

NARRATIVE

Separate diagnostic procedures may be reported in addition to, and apart from, D0140. Radiographs and viral cultures (D0416) are examples of services that may be reported separately. The additional procedures must be deemed necessary by the doctor to evaluate the specific problem/complaint and be supported by a narrative derived from the dentist's clinical notes.