What ADA CDT Dental Code is D0170?
The D0170 dental code is used for a re-evaluation that is limited and problem-focused for established patients. This code applies when a patient returns for follow-up on a specific issue, such as monitoring an ongoing condition or re-assessing a previously identified problem. It is not meant for routine check-ups or post-operative visits.
What Procedure Does D0170 Refer To?
D0170 involves a focused re-evaluation to assess the progress or status of a specific oral health issue. The dentist reviews the condition, updates any relevant diagnostic findings, and determines whether additional treatment or changes to the current plan are needed. This may include a visual examination and diagnostic tests as required.
Documentation Requirements and Best Practices for D0170
- Document Condition Being Monitored: Clearly specify the condition or problem prompting the re-evaluation.
- Update Findings and Progress: Record observations related to the issue, noting any changes since the last visit.
- Recommendations Based on Findings: Document any adjustments to the treatment plan or further diagnostic needs.
- Additional Diagnostic Procedures: If tests or radiographs are used to monitor the condition, include these in the documentation.
How Can I Verify Patient Eligibility and Coverage for D0170?
To verify eligibility and coverage for D0170, contact the patient’s insurance provider. Coverage often depends on the nature of the issue and the frequency of re-evaluations. Some insurance plans may have limits on the number of problem-focused re-evaluations, so confirming eligibility helps prevent unexpected costs for the patient.
How Should D0170 Be Submitted on an Insurance Claim, and Should a Site Be Included?
Submit D0170 with the specific details of the problem being re-evaluated, such as a condition or ongoing issue that requires follow-up (e.g., monitoring of periodontal inflammation). Including these details helps clarify the purpose of the re-evaluation for claim processing.
D0170 Dental Code Cost
The cost of D0170 generally ranges from $40 to $100 without insurance, depending on the provider and location. Patients should consult their dental office for exact pricing based on their insurance plan.
ADA D0170 Guidelines
The ADA recommends D0170 for established patients needing a problem-focused re-evaluation to monitor a specific issue. This code should not be used for routine check-ups or post-operative evaluations but rather for cases requiring follow-up on an ongoing condition.
What is the Difference Between D0170 and Other Similar Codes?
| Code | Description | Purpose |
|---|---|---|
| D0120 | Periodic oral evaluation – established patient | Routine check-up for existing patients |
| D0140 | Limited oral evaluation – problem focused | Exam focused on a specific oral issue |
| D0160 | Detailed and extensive oral evaluation – problem focused, by report | In-depth evaluation and report for complex cases |
| D0170 | Re-evaluation – limited, problem focused (established patient; not post-operative visit) | Follow-up on a specific condition for ongoing monitoring |
Why Was D0170 Specifically Used for My Treatment, and Are There Alternative Treatments with Different Codes and Costs?
D0170 is used for follow-up evaluations to monitor the status of a specific issue, such as gum health or healing progress, in an established patient. If a general check-up is needed instead, D0120 may be more appropriate, or D0140 for an initial problem-focused evaluation. The choice of code depends on whether a re-evaluation or initial assessment is required.
How Often Can You Bill D0170?
D0170 can be billed as needed based on the patient’s condition and the frequency of necessary follow-up visits. Some insurance providers may limit the number of re-evaluations for a particular issue, so it is recommended to verify these guidelines with the patient’s insurance policy.
