Billing Guide for D0272 (Bitewings - two radiographic images)
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Description
Billing Guidelines, Tips and Reminders for D0272 (Bitewings - two radiographic images)
February 02, 2025
WARNING
1. Unless a patient has recent history of caries or other factors, such as progressing periodontal disease, routine six-month or annual bitewing images may be considered unnecessary. Some payors may request refunds for the bitewings, stating the diagnostic images were "medically unnecessary" when documentation does not support the medical necessity of taking the images. When bitewings are taken at six-month intervals, be careful to document the reason the images were taken such as caries risk assessment, recent decay or other caries risk factors. A caries risk assessment demonstrating increased risk, if appropriate (D0602/D0603) should be reported (often at "zero" fee) to support a six-month interval. Documentation supporting the need for bitewings taken in 12-24 month intervals should be made as well.
2. It is misleading to report panoramic radiographic images (D0330) and bitewing images (D0272, D0273 or D0274) as a comprehensive series (D0210). Always report the panoramic/bitewing images separately. The payor may "remap" this radiograph combination to a comprehensive (D0210) series as an alternate benefit. This remapping typically occurs as a result of policy limitations and exclusions in the contract language. For further information on reimbursement policies, see panoramic image (D0330).
Note: The date of service of any radiograph is the date they are interpreted, not the date they are taken. However, when panoramic and bitewing radiographs are taken on the same service date but then routinely split into different dates for interpretation in order to circumvent remapping by the payor to comprehensive series (D0210), this may be seen as a misrepresentation of treatment dates to gain increased reimbursement.
COMMENTS
1. Many offices do not establish, maintain, and adhere to proper bitewing radiographic image protocol as determined and prescribed by the dentist. The type, sequence, and frequency of diagnostic images should be determined by the dentist for each individual patient, based on diagnosis, not based on the patient's plan benefits or limitations. Clinical notation in the patient's chart should reflect the dentist's diagnosis. Diagnostic image guidelines for radiographic images may be found at https://www.ada.org/resources/practice/practice-management/radiographic imaging.
2. Most offices take bitewing radiographic images every 12 months. The most common clinical protocol is to take two bitewing images (D0272) for children, three bitewing images (D0273) or four bitewing images (D0274) for adults (second molars erupted).
3. When the dentist orders a six-month bitewing image interval on a given patient, be careful to document the presence of decay, history of caries, or other risk factors. A caries risk assessment demonstrating increased risk, if appropriate (D0602/D0603) should be reported (often at "zero" fee) to support a six-month interval.
4. Posterior bitewing images taken with a panoramic or CBCT in dedicated bitewing mode are most accurately reported using D0251, reported per radiation. See D0251 for more information.
5. For intraoral - bitewing radiographic image - image capture only, see D0708. Note that D0708 indicates "intraoral".
6. For intraoral tomosynthesis - bitewing radiographic image, see D0373. For image capture only, see D0388.
7. Enter the range of teeth numbers being evaluated in Box 27 of the 2024 ADA Dental Claim Form.
LIMITATIONS
1. There is generally an annual limitation for bitewing reimbursement; however, some payors will further limit bitewing image reimbursement to once every 24 months. Some payors may reimburse bitewing images twice annually for high-risk children under 13 years old. The allowances are more generous for children as they are generally at a higher risk for caries. Reimbursement is dictated by the type of plan purchased and dental necessity.
2. Many plans limit reimbursement for bitewings taken after comprehensive series (D0210) to at least 12 months after the comprehensive series.
3. Bitewing images are generally reimbursed as a preventive service at 100% of the UCR fee. However, some payors reimburse bitewing images as basic (80% of the UCR fee).
TIPS
1. Some policies reimburse for a number of periapical diagnostic radiographic images in addition to two bitewing images (D0272), three bitewing images (D0273), or four bitewing images (D0274) at the recare visit. Some offices report two bitewing images (D0272), three bitewing images (D0273) or four bitewing images (D0274) in addition to several periapicals in order to monitor anterior areas for caries and/or periodontal disease. More payors are requiring narratives and caries risk assessment to support taking periapicals with bitewings. See D0220 for further details.
2. If the second molars have erupted, consider four bitewing images (D0274). There is often no age limitation for reimbursement for three or four bitewing images. If an adult has missing posterior teeth, 2BWX (D0272) or 3BWX (D0273) may be appropriate.
3. Two periapical (D0220/D0230) diagnostic radiographic images are most often the best clinical choice for an emergency evaluation. If a single bitewing image is taken at the emergency evaluation visit, bitewing images may be denied at the next recare visit due to the "once per year/12 months" plan limitation.
4. To monitor the bitewing frequency, if 20% of the practice's prophys are child prophys, approximately 20% of total bitewing radiographic images should be two bitewing radiographic images, not four.
These are horizontal bitewings - two radiographic images.
1. Unless a patient has recent history of caries or other factors, such as progressing periodontal disease, routine six-month or annual bitewing images may be considered unnecessary. Some payors may request refunds for the bitewings, stating the diagnostic images were "medically unnecessary" when documentation does not support the medical necessity of taking the images. When bitewings are taken at six-month intervals, be careful to document the reason the images were taken such as caries risk assessment, recent decay or other caries risk factors. A caries risk assessment demonstrating increased risk, if appropriate (D0602/D0603) should be reported (often at "zero" fee) to support a six-month interval. Documentation supporting the need for bitewings taken in 12-24 month intervals should be made as well.
2. It is misleading to report panoramic radiographic images (D0330) and bitewing images (D0272, D0273 or D0274) as a comprehensive series (D0210). Always report the panoramic/bitewing images separately. The payor may "remap" this radiograph combination to a comprehensive (D0210) series as an alternate benefit. This remapping typically occurs as a result of policy limitations and exclusions in the contract language. For further information on reimbursement policies, see panoramic image (D0330).
Note: The date of service of any radiograph is the date they are interpreted, not the date they are taken. However, when panoramic and bitewing radiographs are taken on the same service date but then routinely split into different dates for interpretation in order to circumvent remapping by the payor to comprehensive series (D0210), this may be seen as a misrepresentation of treatment dates to gain increased reimbursement.
COMMENTS
1. Many offices do not establish, maintain, and adhere to proper bitewing radiographic image protocol as determined and prescribed by the dentist. The type, sequence, and frequency of diagnostic images should be determined by the dentist for each individual patient, based on diagnosis, not based on the patient's plan benefits or limitations. Clinical notation in the patient's chart should reflect the dentist's diagnosis. Diagnostic image guidelines for radiographic images may be found at https://www.ada.org/resources/practice/practice-management/radiographic imaging.
2. Most offices take bitewing radiographic images every 12 months. The most common clinical protocol is to take two bitewing images (D0272) for children, three bitewing images (D0273) or four bitewing images (D0274) for adults (second molars erupted).
3. When the dentist orders a six-month bitewing image interval on a given patient, be careful to document the presence of decay, history of caries, or other risk factors. A caries risk assessment demonstrating increased risk, if appropriate (D0602/D0603) should be reported (often at "zero" fee) to support a six-month interval.
4. Posterior bitewing images taken with a panoramic or CBCT in dedicated bitewing mode are most accurately reported using D0251, reported per radiation. See D0251 for more information.
5. For intraoral - bitewing radiographic image - image capture only, see D0708. Note that D0708 indicates "intraoral".
6. For intraoral tomosynthesis - bitewing radiographic image, see D0373. For image capture only, see D0388.
7. Enter the range of teeth numbers being evaluated in Box 27 of the 2024 ADA Dental Claim Form.
LIMITATIONS
1. There is generally an annual limitation for bitewing reimbursement; however, some payors will further limit bitewing image reimbursement to once every 24 months. Some payors may reimburse bitewing images twice annually for high-risk children under 13 years old. The allowances are more generous for children as they are generally at a higher risk for caries. Reimbursement is dictated by the type of plan purchased and dental necessity.
2. Many plans limit reimbursement for bitewings taken after comprehensive series (D0210) to at least 12 months after the comprehensive series.
3. Bitewing images are generally reimbursed as a preventive service at 100% of the UCR fee. However, some payors reimburse bitewing images as basic (80% of the UCR fee).
TIPS
1. Some policies reimburse for a number of periapical diagnostic radiographic images in addition to two bitewing images (D0272), three bitewing images (D0273), or four bitewing images (D0274) at the recare visit. Some offices report two bitewing images (D0272), three bitewing images (D0273) or four bitewing images (D0274) in addition to several periapicals in order to monitor anterior areas for caries and/or periodontal disease. More payors are requiring narratives and caries risk assessment to support taking periapicals with bitewings. See D0220 for further details.
2. If the second molars have erupted, consider four bitewing images (D0274). There is often no age limitation for reimbursement for three or four bitewing images. If an adult has missing posterior teeth, 2BWX (D0272) or 3BWX (D0273) may be appropriate.
3. Two periapical (D0220/D0230) diagnostic radiographic images are most often the best clinical choice for an emergency evaluation. If a single bitewing image is taken at the emergency evaluation visit, bitewing images may be denied at the next recare visit due to the "once per year/12 months" plan limitation.
4. To monitor the bitewing frequency, if 20% of the practice's prophys are child prophys, approximately 20% of total bitewing radiographic images should be two bitewing radiographic images, not four.
These are horizontal bitewings - two radiographic images.