Consultation/Evaluation Code Confusion?
When is a consultation code more appropriate than an evaluation procedure?
D9310 Consultation – diagnostic service provided by dentist or physician other than requesting dentist or physician
A patient encounter with a practitioner whose opinion or advice regarding evaluation and/or management of a specific problem; may be requested by another practitioner or appropriate source. The consultation includes an oral evaluation. The consulted practitioner may initiate diagnostic and/or therapeutic services.
In the “World According to Joan” typically the D9310 is reported when one dentist refers their patient to another dentist for an opinion, or for advice on a particular problem the patient presented with.
Which brings me to another scenario….what code should the dentist who sees the patient referred by another dentist (for an evaluation of the specific problem) report?
A problem focused evaluation code (D0140 or D0160) or the consultation code D9310?
Well, both the D0140 and D0160 are both problem focused evaluations…
D0140 limited oral evaluation – problem focused
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 patients receiving this type of evaluation present with a specific problem and/or dental emergencies, trauma, acute infections, etc.
D0160 detailed and extensive oral evaluation – problem focused, by report
A detailed and extensive problem focused evaluation entails extensive diagnostic and cognitive modalities based on the findings of a comprehensive oral evaluation. Integration of more extensive diagnostic modalities to develop a treatment plan for a specific problem is required. The condition requiring this type of evaluation should be described and documented.
Examples of conditions requiring this type of evaluation may include dentofacial anomalies, complicated perio-prosthetic conditions, complex tempomandibular dysfunction, facial pain of unknown origin, conditions requiring multi-disciplinary consultation, etc.
In my opinion, either one may be reported if the dentist providing the consultation feels the code describes the service reported. READ THE DESCRIPTOR LANGUAGE to make sure it accurately describes the service you provided.
There is no language in either one of the descriptors or nomenclature(title) that would prohibit the consulting dentist from initiating and/or reporting additional services. These would be reported separately using the most appropriate code.
D9310 Consultation – diagnostic service provided by dentist or physician other than requesting dentist or physician.
This may be used if the consulting dentist feels it more accurately describes the service provided. According to the CDT descriptor the dentist who is consulted may initiate additional diagnostic procedures or therapeutic services for this patient as well. These again would be reported separately with their own unique respective codes.