When is D0274 used?
The D0274 dental code corresponds to "bitewings – four radiographic images" according to the Current Dental Terminology (CDT) guidelines. This code applies when dental professionals capture four individual bitewing X-rays in one appointment, primarily for examining the contact areas between posterior teeth to detect decay, evaluate bone loss, or identify other dental conditions. D0274 is typically appropriate for adult patients or mature children who have all their back teeth, where fewer than four bitewing images wouldn't offer complete diagnostic information. It's crucial to apply D0274 only when four radiographs are medically justified; for fewer images, select the correct alternative code, such as D0272 for two bitewing radiographs.
Record Keeping and Clinical Applications
Accurate record keeping is vital for obtaining reimbursement and maintaining regulatory compliance. When utilizing D0274, make certain the patient's file clearly shows the medical justification for capturing four bitewing radiographs. Typical situations include standard cavity screening for adults, tracking gum disease progression, or checking for decay around existing dental work. Recommended practices include:
Recording the medical necessity for the X-rays (e.g., "standard decay screening," "gum disease monitoring").
Specifying the quantity of images captured and their diagnostic value.
Storing radiographic files in the patient's record and including them with insurance submissions when needed.
Thorough record keeping not only facilitates claim acceptance but also safeguards the practice during potential reviews or audits.
Strategies for Insurance Claims
When submitting D0274 claims, dental staff should confirm patient insurance coverage prior to the visit. Most insurance policies allow bitewing radiographs annually or every twelve months, though coverage frequency and patient age requirements may differ. Use these guidelines for better billing results:
Confirm coverage and frequency restrictions during benefit verification calls.
Include supporting documentation when submitting claims if the patient's medical history justifies more frequent imaging.
Examine Explanation of Benefits statements for rejection reasons and prepare to appeal with additional clinical information when appropriate.
Select the appropriate CDT code based on actual images taken—incorrect coding may result in claim rejections or regulatory problems.
Clear upfront discussions with patients regarding their insurance benefits and possible expenses helps prevent billing disputes and enhances patient relationships.
D0274 Case Study
Take a 45-year-old patient coming in for their regular dental examination. The dentist decides four bitewing radiographs are necessary to screen for tooth decay between teeth and evaluate bone health given the patient's gum disease background. The clinical team records the medical reasoning in the chart, writing "standard decay and gum disease evaluation." Four bitewing radiographs are captured and stored in the file. Insurance benefit verification shows the patient qualifies for annual bitewing coverage. The claim gets processed using D0274, and the insurance payment comes through completely due to proper coding and complete documentation.
Following these guidelines helps dental practices use D0274 correctly, reduce claim rejections, and stay compliant with insurance policies.
FAQ
Are there age limitations when using dental code D0274?
D0274 does not have specific age limitations, though it's primarily utilized for adult patients and older children who have developed permanent teeth. Regardless of the patient's age, proper clinical documentation justifying the need for four bitewing radiographs is essential.
Is it possible to bill D0274 together with other radiographic procedures in a single appointment?
Yes, D0274 may be billed with other radiographic codes like periapical or panoramic X-rays when there is clear clinical justification. Keep in mind that certain insurance providers may bundle radiographic services together or impose limits on reimbursable images per appointment. It's important to verify the patient's insurance coverage and maintain thorough documentation explaining the medical necessity for each imaging procedure performed.
How should a dental practice handle situations where patient insurance doesn't cover D0274?
When patient insurance doesn't provide coverage for D0274, the dental practice should notify the patient prior to performing the procedure, explore suitable alternative imaging methods when applicable, and secure a signed financial responsibility agreement. Additionally, the practice may submit a detailed explanation or file an appeal with the insurance carrier when there is compelling clinical evidence supporting the necessity of the four bitewing radiographs.