CDT code D0191

A reader asked:

I just read your article in Dental Economics regarding the CDT Coding process. It was very well written and super informative. I have a CDT coding question that I’d like to run past you….I practice Dental Hygiene in Wisconsin and recently learned about CDT code D0191 – Dental Hygiene Assessment. Do you see many offices using this code and if so, are they using it for documentation purposes only or might an insurance company sometimes pay towards it?

Patti responded:

There are really two of what are called Pre-Diagnostic Codes in CDT. There are not dental hygiene assessment per se. This is how they read:

  • D0190 screening of a patient. A screening, including state or federally mandated screenings, to determine an individual’s need to be seen by a dentist for diagnosis.
  • D0191 assessment of a patient. A limited clinical inspection that is performed to identify possible signs of oral or systemic disease, malformation, or injury, and the potential need for referral for diagnosis and treatment.

As far as offices using this code, I don’t know. My guess is not much. What would be the reason? I know when I talk about teledentistry, these codes can more utility. Yet that market penetration on that is limited.

Then there is the discussion of coverage vs. coding. I know I have talked with Angie Stone about her work and my co-travel. Why? Because it is my guess there are codes that could and should be used. As you mentioned, documentation is equally if not more important for the metrics they represent. How do we know how many this or that we have performed unless we have a code and use a code? In addition, HIPAA in 2001 identified CDT as the standard code set for dentistry. That means it is the set for electronic health records. This takes the 3rd party reimbursement out of the equation. Even if there is no 3rd party involved, we are required to use CDT codes in dentistry. Can we also use ICD and other medical coding? Yes but that is a different subject though one we may want to begin to consider.

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