When is D0190 used?
The D0190 dental code applies to patient screenings that assess the need for additional dental care. This code is typically utilized during community health initiatives, public health programs, or preliminary appointments where a complete examination isn't conducted. It serves as a preliminary assessment rather than replacing thorough examinations like comprehensive oral evaluation (D0150), helping identify patients requiring more detailed treatment. Apply D0190 during brief evaluations, particularly in non-traditional dental environments, or when quick assessments are necessary to determine treatment priority or specialist referrals.
Record Keeping and Practice Examples
Proper record keeping is essential when using D0190. Clinical documentation must clearly indicate that a screening occurred, detail observations made, and specify whether additional evaluation or care is suggested. Typical applications include educational institution screenings, community wellness events, or urgent care assessments. For instance, when a dental professional conducts visual examinations at schools and identifies apparent decay or immediate concerns, D0190 is the correct code. Always record the patient's primary concern, screening results, and recommendations for continued care or referrals. This practice ensures regulatory compliance, supports claim processing, and creates reliable documentation for potential insurance reviews.
Reimbursement Guidelines
Processing D0190 claims requires knowledge of individual insurance policies, since screening coverage varies among dental plans. Prior to claim submission, confirm benefits with the patient's insurer. When filing claims, attach comprehensive clinical documentation and relevant supporting materials. If claims face rejection, examine the Explanation of Benefits for denial reasons and consider filing appeals with supplementary evidence. Well-organized practices frequently employ verification protocols to confirm all required documentation accompanies submissions, minimizing rejection rates. For uninsured patients, maintain transparency regarding personal expenses and establish clear payment expectations.
Practical D0190 Application
Imagine a dental practice participating in a community wellness event. A patient approaches with complaints of dental discomfort. A hygienist conducts a visual and manual screening, observes minor gum irritation, and suggests scheduling a full examination at their clinic. This encounter is recorded as D0190 screening, with observations and suggestions thoroughly documented. The administrative staff confirms the patient's insurance includes screening benefits, processes the claim with detailed notes, and monitors the EOB to verify appropriate payment. This example demonstrates effective D0190 implementation in community outreach programs.
FAQ
Who is authorized to perform and bill for D0190 - dental hygienists or dentists only?
Licensed dental hygienists are typically permitted to perform and document D0190 screenings, subject to state regulatory requirements and the supervising dentist's established protocols. To ensure proper compliance when billing D0190 for hygienist-provided services, practices must always confirm their state's specific scope of practice regulations.
Are there restrictions on how frequently D0190 can be billed for individual patients?
Although CDT guidelines don't establish specific limits, most dental insurance carriers do impose frequency restrictions on preventive and screening procedures like D0190. These limitations commonly restrict billing to once annually or per qualifying event for each patient. It's essential to verify the specific frequency restrictions with each patient's insurance provider prior to submitting claims.
Is it permissible to bill D0190 alongside other preventive treatments like fluoride applications or sealants during the same visit?
D0190 may be billed concurrently with preventive treatments such as fluoride applications or sealants on the same date of service, provided the procedures are clearly distinct and thoroughly documented. However, D0190 cannot be billed together with comprehensive or periodic evaluations on the same visit. It's important to verify individual payer policies regarding acceptable service combinations before billing.