Billing Guide for D0274 (Bitewings - Four Radiographic Images)
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Description
Billing Guidelines, Tips and Reminders for D0274 (Bitewings - Four 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 radiographic images may be considered dentally unnecessary. Some payors have requested reimbursement for the bitewings, stating the diagnostic radiographic 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(s) the images are taken such as 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 six-month intervals. Documentation supporting the exposure of 12 to 24 month bitewing radiographic images should be made as well.
2. It is misleading to report extra-oral panoramic radiographic image (D0330) and intra-oral bitewing radiographic images (D0272, D0273 or D0274) as a comprehensive series (D0210). Always report the panoramic/bitewing radiographic images separately as taken. The payor may "remap" this radiographic image combination to a comprehensive (D0210) series as an alternative payment. This remapping typically occurs as a result of policy limitations and exclusions in the contract language. For further information on reimbursement policies, also see panoramic radiographic 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 enforce proper bitewing 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 12-24 months; bitewings - two radiographic images (D0272) for children and bitewings - three radiographic images (D0273) or bitewing radiographic images - four radiographic images (D0274) for adults (second molars erupted) as an adjunct to diagnosis at the recare visit. This is the most common clinical protocol but no matter the protocol, the dentist must evaluate each patient and then prescribe which radiographic images, if any, should be taken.
3. Generally, age is not an issue for reimbursement of either three (D0273) or four (D0274) bitewing radiographic images. However, frequency limits may be age limited with some payors.
4. When the dentist orders a six-month bitewing image interval on a given patient, be sure to document the reason for taking the images (e.g., the presence of decay, history of caries, or other high-risk factors). 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.
5. 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.
6. For intraoral bitewing radiographic image - image capture only, see D0708. Note that D0708 indicates "intraoral".
7. For intraoral tomosynthesis - bitewing radiographic image, see D0373. For image capture only, see D0388.
8. 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 image reimbursement; however, some payors will further limit bitewing radiographic image reimbursement to once every 24 months. Some payers will reimburse bitewing radiographs twice annual for high risk children as they are generally at a higher risk for caries. This determination is based on the pan purchased by the employer and by established dental necessity for the patient.
2. Many plants have a 12-month limitation exclusion for bitewing radiographic images after the exposure of a comprehensive series (D0210).
3. Bitewing radiographic images are generally reimbursed as a preventive service at 100% of the payor’s fee. However, some payors reimburse as basic (80% of the payor’s fee).
TIPS
1. Some policies reimburse for several periapical diagnostic radiographic images in addition to the three bitewing radiographic images (D0273) or four bitewing radiographic images (D0274) at the recare visit. Some offices report three bitewing radiographic images (D0273) or four bitewing radiographic images (D0274) in addition to several periapicals in order to monitor anterior areas of caries and/or periodontal disease. A caries risk assessment demonstrating increased risk, if appropriate, (D0602/D0603) should be reported (often at "zero" fee) to support six- month intervals.
2. If the second molars have erupted for a child, consider four bitewing radiographic images (D0274).
3. Two periapical (D0220/D0230) diagnostic radiographic images are most often the clinical choice at an emergency evaluation. If a bitewing image is reported on an emergency evaluation service date, bitewing radiographic images may be denied at the next recare service date, due to the "once per year/12 months" limitations, generally in effect for bitewing diagnostic radiographic images.
4. See full mouth debridement to enable comprehensive evaluation (D4355) for diagnostic image sequence options. 5. If 80% of prophylaxis counts are adults, then it would follow that approximately 80% of total bitewings would be three and/or four bitewing radiographic images.
6. Bitewings - three radiographic images (D0273) may be appropriate for the adult patient who is missing posterior teeth on one or both sides.
1. Unless a patient has recent history of caries or other factors, such as progressing periodontal disease, routine six-month or annual bitewing radiographic images may be considered dentally unnecessary. Some payors have requested reimbursement for the bitewings, stating the diagnostic radiographic 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(s) the images are taken such as 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 six-month intervals. Documentation supporting the exposure of 12 to 24 month bitewing radiographic images should be made as well.
2. It is misleading to report extra-oral panoramic radiographic image (D0330) and intra-oral bitewing radiographic images (D0272, D0273 or D0274) as a comprehensive series (D0210). Always report the panoramic/bitewing radiographic images separately as taken. The payor may "remap" this radiographic image combination to a comprehensive (D0210) series as an alternative payment. This remapping typically occurs as a result of policy limitations and exclusions in the contract language. For further information on reimbursement policies, also see panoramic radiographic 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 enforce proper bitewing 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 12-24 months; bitewings - two radiographic images (D0272) for children and bitewings - three radiographic images (D0273) or bitewing radiographic images - four radiographic images (D0274) for adults (second molars erupted) as an adjunct to diagnosis at the recare visit. This is the most common clinical protocol but no matter the protocol, the dentist must evaluate each patient and then prescribe which radiographic images, if any, should be taken.
3. Generally, age is not an issue for reimbursement of either three (D0273) or four (D0274) bitewing radiographic images. However, frequency limits may be age limited with some payors.
4. When the dentist orders a six-month bitewing image interval on a given patient, be sure to document the reason for taking the images (e.g., the presence of decay, history of caries, or other high-risk factors). 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.
5. 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.
6. For intraoral bitewing radiographic image - image capture only, see D0708. Note that D0708 indicates "intraoral".
7. For intraoral tomosynthesis - bitewing radiographic image, see D0373. For image capture only, see D0388.
8. 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 image reimbursement; however, some payors will further limit bitewing radiographic image reimbursement to once every 24 months. Some payers will reimburse bitewing radiographs twice annual for high risk children as they are generally at a higher risk for caries. This determination is based on the pan purchased by the employer and by established dental necessity for the patient.
2. Many plants have a 12-month limitation exclusion for bitewing radiographic images after the exposure of a comprehensive series (D0210).
3. Bitewing radiographic images are generally reimbursed as a preventive service at 100% of the payor’s fee. However, some payors reimburse as basic (80% of the payor’s fee).
TIPS
1. Some policies reimburse for several periapical diagnostic radiographic images in addition to the three bitewing radiographic images (D0273) or four bitewing radiographic images (D0274) at the recare visit. Some offices report three bitewing radiographic images (D0273) or four bitewing radiographic images (D0274) in addition to several periapicals in order to monitor anterior areas of caries and/or periodontal disease. A caries risk assessment demonstrating increased risk, if appropriate, (D0602/D0603) should be reported (often at "zero" fee) to support six- month intervals.
2. If the second molars have erupted for a child, consider four bitewing radiographic images (D0274).
3. Two periapical (D0220/D0230) diagnostic radiographic images are most often the clinical choice at an emergency evaluation. If a bitewing image is reported on an emergency evaluation service date, bitewing radiographic images may be denied at the next recare service date, due to the "once per year/12 months" limitations, generally in effect for bitewing diagnostic radiographic images.
4. See full mouth debridement to enable comprehensive evaluation (D4355) for diagnostic image sequence options. 5. If 80% of prophylaxis counts are adults, then it would follow that approximately 80% of total bitewings would be three and/or four bitewing radiographic images.
6. Bitewings - three radiographic images (D0273) may be appropriate for the adult patient who is missing posterior teeth on one or both sides.