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    The 5 biggest misconceptions about imaging coding and reimbursement

     

    All images are the same

    The technology used to capture the image matters:  CBCT services are viewed differently from conventional dental radiographic images. The reimbursement for CBCT is not based on the image(s) produced using CBCT. The reimbursement for CBCT is based on two variables:

    • The area involved in the capture of data
    • The interpretation of the image.

    This system more closely mirrors the billing/coding system seen in medicine where a facility captures the image and a radiologist interprets the image. So, if CBCT technology is used to capture data associated with a “field of view of both jaws; with or without cranium,” any subsequent images produced from this capture would be included in this “pack” of data captured, 2D or 3D. Additionally, the multiple images that can be produced from the pack of data should not be billed separately. The billing of multiple individual images produced from the pack of data including a “field of view of both jaws; with or without cranium” could be consider unbundling and potentially problematic. The best code(s) used to describe the use of CBCT technology are the CBCT codes, not the conventional 2D radiographic image codes.

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    Looking at the interpretation variable associated with CBCT technology, codes were developed to describe situations where the CBCT information was either:

    • Captured (not interpreted) by a provider
    • Captured and interpreted by a provider
    • Instances where the information is only interpreted by a provider

    (The submission for reimbursement of the interpretation of the image has also been limited to “a practitioner not associated with capture of the image” and the individual who only interprets the image must produce a “report” of their findings). This means that multiple dentists practicing in the same location or other dentists who have ownership of the CBCT machine may not bill for an additional interpretation of the CBCT.

    Continue to page four for more...

     

    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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