Expert: Mark Bornfeld DDS - 3/21/2009

Question
As a working hygienist, I have a question about periodontal screenings - specifically probe and chart.  I do "spot" probings at every periodic exam and check the "problem" areas and we have a full charting (basically just the 6 readings of each tooth) every year or two.  I say this is part of the charge of the periodic exams.  One of the dentists I work for would like to now add a fee each time we write down or "chart" the 6 readings -- $23.00.  So this would be a separate fee on top of the charge for the exam.  Is this legitimate?  Ethical?  Fraudulent?

Answer
Dear Liz,

Although there is a separate CDT code for comprehensive periodontal exams (D0180), it is customary to charge only one of the "oral examination" fees on a given date. Insurance companies will not pay more than one benefit for an oral examination of any variety (D0150, D0210, D0160, D0170, or D0180) on one treatment visit. This makes intuitive sense, because it raises the question of how to unbundle an oral examination into its component parts. What is an examination-- a caries examination? An occlusal examination? An oral cancer examination? A periodontal examination? By what criteria can you dissect a diagnostic session into its component parts, and what are those parts?

Unbundling is a strategy sometimes used to justify additional fees, and it is certainly not limited to the diagnostic area. I have witnessed some dentists unbundling an endodontic procedure, for example, into separate billable services such as local anesthesia, measurement x-rays, tooth isolation, and the procedure itself. Time and again, this practice has been ruled to be unethical.

If your dentist wants to charge a higher fee for a more intensive examination, he is certainly entitled to do it. However, it is considered improper to imply that he is providing an additional, separate service. He is not.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY