By Teresa Duncan, MS
2013 is off to a great start, and judging by the feedback, the new fluoride code took many of you by surprise.
Let’s continue the new code discussion with the new cone beam computed tomography, CBCT, codes that were introduced. The new codes are:
D0364: CBCT capture and interpretation with a limited field of view – less than one whole jaw
D0365: CBCT capture and interpretation with field of view of one full dental arch – mandible (lower jaw)
D0366: CBCT capture and interpretation with field of view of one full dental arch – maxillary (upper arch) with or without cranium
D0367: CBCT capture and interpretation with field of view of both jaws, with or without cranium
D0368: CBCT capture and interpretation for TMJ series including two or more exposures
D0380: CBCT image capture with limited field of view – less than one whole jaw
D0381: CBCT image capture with field of view of one full dental arch – mandible (lower jaw)
D0382: CBCT image capture with field of view of one full dental arch – maxillary (upper arch) with or without cranium
D0383: CBCT image capture with field of view of both jaws, with or without cranium
D0384: CBCT image capture for TMJ series including two or more exposures
Take these codes out of your database:
D0360: CBCT – craniofacial data capture
D0362: Cone beam – 2-D image reconstruction using existing data
As you can see, the codes have been expanded greatly to differentiate between the level of services and areas of focus. Cone beam images must first be acquired, then reconstructed so that they may be interpreted or read. Some dental offices have the capability to take the image capture but not to interpret the reconstructed images. In that case the images are sent directly to a radiologist for interpretation.
Radiologists are able to interpret and diagnosis not only dental-related conditions, but any others that are in the image’s field of view. There has been concern that dentists should be responsible for disclosing any found conditions, even if they are not directly related to teeth. However, the emergence of “focused field” machines helps minimize any liability that could be attached to the dentist. Focused field machines only show the area that is relevant to treatment. For example, if a dentist plans to place an implant in the lower right quadrant, then the CBCT machine takes images only of this particular area. In this case the code would be D0364 — capture and interpretation with a limited field of view, less than one whole jaw.
It’s still too early to tell how insurance companies will reimburse for these codes. If a plan already reimburses for CBCT, then the new codes will also be covered but at different pricing to take into account the amount of time and expertise. To be safe, use your electronic claims software to verify if it’s a benefit. If you receive benefits in real-time, you could send in a pretreatment estimate for the codes to learn any estimated payments. As more offices implement CBCT protocol, expect to see coverage increase in higher-level plans. My clients have reported a range of 100% coverage to 80% coverage with applied deductible. If you notice that coverage is different, I welcome emails so that I can pass this information onto readers. Our collective knowledge of insurance helps us all to become better coders.
Teresa Duncan, MS, FADIA, FAADOM, is an international speaker who addresses topics such as insurance coding, office manager training, and revenue growth. Her company, Odyssey Management, Inc., provides virtual, customized training in these areas. She can be reached at [email protected].
Editor's Note: The dental procedures codes ("Code") are owned and published by the American Dental Association ("ADA") in its reference manual Current Dental Terminology ("CDT"). The ADA is the exclusive owner and copyright holder of the CDT, including the Code, as well as of the ADA claim form.
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