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An Exam Is Not An Evaluation

Posted On: Friday, January 4th 2013 by

True or False: Codes DO120 through DO180 can be applied as exam codes.

False!

In actuality, they are evaluation codes with the exam being one aspect of the evaluation. The definitions below spell this out:

Exam: n. An examination; a test.
Evaluation:
1. To ascertain or fix the value or worth of.
2. To examine and judge carefully; appraise.

In the article, Don’t Fail Your Next Exam, Dr. Charles Blair explains that the exam is a part of the evaluation process, but an exam is not an evaluation. An evaluation has been completed when the doctor uses the information gathered during the exam process to arrive at a comprehensive assessment of that information. An examination and/or tests are done as part of the process, but an evaluation is not complete until an appraisal of the information is complete.

Doing an exam does not meet the criteria established for application of the billing codes D0120 – D0180. Unless an evaluation of the exam information is done (and recorded in the chart) the components of the evaluation have not been completed and should not be coded and billed.

Why is it important? The health care culture is changing as we move toward a more global health care community. With the ADA Code Advisory Committee and insurance carriers moving toward a more diagnosis/evaluation-driven treatment foundation, evaluations become increasingly important.

Dr. Charles Blair looks at clinical scenarios to help differentiate between evaluation codes, outlining some basic misconceptions about the understanding of each. Read more and pass your next exam with flying colors.

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