Periodontal Coding, CPE and Insurance Payments
Hello Fellow Hygienists. I have a question that has been going unanswered in our dental office and keeps us scratching our heads. For our Periodontal patients that come to our office every 3-4 months, we perform a Comprehensive Periodontal Evaluation (CPE- code: 0180) 1 time every year. We have been finding that most insurance companies have been denying coverage stating, a CPE can only be performed 1 time every 3-5 years, or if they are a new patient. The American Academy of Periodontology (AAP) states that CPE is the standard of care and should be performed annually. See link: http://www.joponline.org/doi/full/10.1902/jop.2011.117001. At our office we feel that this service should be completed on our patients who are periodontally involved to keep a close eye on their disease. Speaking to the insurance company, we asked if sending in the charting, radiographs and clinical notes, could allow for more coverage. They have told us 'NO', and that they have specific guidelines to follow and that the fee for our CPE gets reduced to code 0120. Does anyone have any suggestions? How can we get denied coverage for a service that is so needed on an annual basis... Thanks in advance!
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