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    The 5 biggest misconceptions about imaging coding and reimbursement

    Dental technology and the material sciences are advancing at a rate never before experienced by the dental industry. It is difficult, if not impossible, for the average practitioner to understand and appreciate all the new “stuff” that has been developed and introduced to dentistry over the past 10 years. Things that not too long ago seemed like science fiction have now become reality.

    Many of those new technologies, materials and techniques are rapidly becoming commonplace in the average dental practice and most will see widespread use in nearly every dental practice in the very near future. That’s the good news for both our patients and for the doctors who implement these new advances. The bad news: Reimbursement for these new technologies, materials and techniques has not maintained the same pace of advancement.

    In fact, the ADA’s Code Maintenance Committee has been challenged to keep up with this trend. In many instances, technology, materials and techniques that were once used and easily described by the CDT code set are now obsolete and have been replaced by newer diagnostic and treatment solutions.The adoption of codes that best describe the service provided is sometimes hindered by the fact that it takes time for dental researchers to provide enough evidence to support the efficacy of the new technology, material or technique for a code to be adopted to describe it. In most cases codes will not be considered for addition to the CDT to describe services where there is insufficient evidence based support for the service.

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    In today’s world, the new advancement is introduced to the market before potential insurance reimbursement for that new advancement is ever considered. These are a couple of the reasons why the code committee is struggling to maintain a code set that adequately describes the many new products and procedures used today. If the powers that be are challenged to keep up, how about the practice that is working diligently to code the procedure appropriately? The larger, more daunting question may be: “Now that I’ve bought the newest, latest, and greatest ___, how do I get paid for using it?” Unfortunately, the venders of the technology, product or service may not be providing accurate information to the practice regarding the associated coding of that technology, product or service.

    In the case where there is a code that accurately describes the procedure, understand that just because a code exists that describes the procedure, this does not mean that the insurance carrier must reimburse it. The practice must always submit claims for services using the code that best describes what was done and then let the carrier process the claim according to the parameters established in the plan. If there is no code that currently exists to describe the service, the non-specified codes (DX999) should be used.

    So, specifically, how does all this affect dental images? Continue to page two to read about the five biggest image misconceptions.


    Dr. Roy Shelburne
    Dr. Shelburne, an honor graduate from VCU’s dental school, opened a private general practice in Pennington Gap, Va., in 1981. In 2008, ...


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