When is D0367 used?
The D0367 dental code applies to cone beam computed tomography (CBCT) imaging and analysis with a field of view that encompasses both upper and lower jaws, potentially including the skull. This CDT code is suitable when comprehensive 3D imaging is required for diagnostic evaluation, treatment planning, or surgical procedures—including assessing impacted teeth, examining pathological conditions, planning dental implants, or managing complex orthodontic treatments. This code is not intended for limited or focused scans; refer to appropriate alternative codes for those situations.
Record Keeping and Clinical Applications
Proper documentation is essential for claim approval and regulatory compliance. When utilizing D0367, make sure these elements are present in the patient file:
Medical justification: Provide a clear explanation for ordering the CBCT scan (e.g., dental implant planning, pathology evaluation, or comprehensive oral assessment).
Imaging scope: Record that both upper and lower jaws were imaged, noting if skull structures were also captured.
Professional analysis: Include a documented radiographic evaluation by the treating dentist or qualified specialist.
Image storage: Maintain and archive the complete CBCT images within the patient's electronic records.
Typical clinical applications for D0367 encompass full-mouth implant treatment planning, evaluation of multiple impacted teeth, or assessment of widespread jaw abnormalities. For targeted, smaller area scans, utilize codes like D0364 (restricted field of view) or D0365 (individual arch).
Insurance Reimbursement Strategies
Successfully billing D0367 demands careful attention and proactive insurance communication. Follow these recommendations to optimize payment:
Prior approval: Confirm coverage details and secure prior authorization when mandated by the patient's dental or medical plan. Supply clinical documentation and scan rationale.
Proper coding: Apply D0367 exclusively when imaging encompasses both jaws. Avoid inappropriate coding for extended fields of view without clinical justification.
Supporting documentation: Include the radiological assessment and CBCT image copies or screenshots with your claim submission. This demonstrates medical necessity and expedites claim review.
Claim reviews: When claims are rejected, examine the Explanation of Benefits (EOB) for denial reasons and file a comprehensive appeal including supplementary documentation, clinical records, and necessity letters.
Note that certain dental insurance plans may classify D0367 as a medical procedure. When this occurs, coordinate with the patient's health insurance and adhere to their specific submission requirements.
D0367 Application Example
Scenario: A 55-year-old individual requires complete mouth implant restoration. The practitioner decides a comprehensive CBCT examination is essential to assess bone density, nerve positioning, and sinus anatomy across both jaws.
Process:
Document detailed clinical notes explaining the necessity for comprehensive jaw imaging.
Perform the CBCT examination, confirming both upper and lower jaws are within the imaging field.
Analyze and record all findings in the patient's medical record.
Confirm insurance benefits and file a claim using D0367, including the radiological assessment and imaging files.
For denied claims, examine the EOB and file an appeal with supplementary documentation when required.
This systematic approach ensures proper billing practices, regulatory compliance, and maximum reimbursement for advanced diagnostic imaging procedures.
FAQ
Can D0367 be billed together with other CBCT codes during the same patient appointment?
No, D0367 cannot be billed alongside other CBCT codes for the same anatomical region in a single visit. Because D0367 encompasses both the capture and interpretation of a complete jaw scan, submitting additional CBCT codes for overlapping or identical areas may constitute duplicate billing. This practice can result in claim denials or trigger insurance audits. It's essential to select the single most appropriate code that accurately represents the extent of the scan performed.
What patient consent requirements apply to D0367 CBCT scans?
Obtaining informed consent is strongly recommended prior to conducting a D0367 CBCT scan. Patients must be informed about the scan's purpose, anticipated benefits, and potential risks, particularly radiation exposure. Proper documentation of the patient's consent in their clinical record fulfills ethical obligations and provides valuable support for your claim should an insurance audit occur.
What are the billing frequency limitations for D0367 with the same patient?
The billing frequency for D0367 varies based on the patient's clinical requirements and their insurance carrier's specific guidelines. Most insurance providers will only authorize coverage for CBCT scans like D0367 when medically necessary, not for routine screening purposes. Multiple scans performed within a brief period may require enhanced justification and comprehensive documentation to establish medical necessity. It's advisable to verify frequency restrictions with the payer and secure pre-authorization when required.