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    The 5 biggest misconceptions about imaging coding and reimbursement



    The use of new technology will yield higher reimbursement 

    Existing standards of care ultimately dictate what the carriers consider for reimbursement and frankly should help guide the dentist in making diagnostic and treatment decisions. In today’s world, standards of care are established by evidence-based review and like the technology we use, are evolving.

    The more we know (by testing and outcomes), the more dental standards are changing. Relating this to the dental imaging world (based on the prevailing standards of care) should every patient be exposed to a CBCT?  The answer is no, unless that patient is having implants placed, wisdom teeth removed or some other service where the standard establishes a CBCT review should be conducted before proceeding with treatment.

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    Should that scan be needed to provide the prevailing standard of care in anticipation of a “qualified” treatment, yes. To take a CBCT on a patient that does not have a condition where the standard requires a CBCT could be considered overkill, medically unnecessary, and would not be considered for reimbursement by the patient’s insurance carrier and potentially problematic.

    Many carriers will reimburse CBCT technology when the claim is supported with information that establishes the medical necessity (prior to implants if implants are covered by the plan or oral surgery that could damage surrounding structures). CBCT technology will not be considered for reimbursement in situations where the CBCT is deemed medically unnecessary based on prevailing standards of care. Bottom line, the practice should not use CBCT technology to generate a PA.

    Continue to page five 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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