When is D0368 used?
The D0368 dental code applies to cone beam computed tomography (CBCT) imaging and analysis for temporomandibular joint (TMJ) evaluation, requiring a minimum of two exposures. Dental professionals should utilize this code when conducting CBCT scans specifically designed to assess TMJ conditions, obtaining multiple exposures to create a thorough examination of the joint's structure and performance. D0368 cannot be used for single-view CBCT procedures or cone beam imaging unrelated to TMJ diagnosis. Correct application of this code guarantees precise clinical records and appropriate compensation for sophisticated diagnostic imaging procedures focused on TMJ conditions.
Record Keeping and Patient Scenarios
Supporting the application of D0368 requires dental offices to keep comprehensive records. Essential documentation includes:
Complete clinical records outlining TMJ-related symptoms (such as discomfort, joint sounds, restricted jaw movement).
Medical justification for requesting the CBCT procedure (such as possible disc displacement, surgical planning, or trauma assessment).
Analysis summary completed by the treating dentist or imaging specialist, documenting observations from multiple exposures.
Digital images maintained in patient files for future reference and compliance review.
Typical patient situations warranting D0368 include individuals experiencing persistent TMJ discomfort, potential joint abnormalities, or those needing assessment before orthodontic or surgical treatment. Documentation must clearly establish the clinical necessity to validate insurance submissions.
Reimbursement and Claims Processing Guidelines
Proper billing procedures for D0368 enhance reimbursement success and reduce claim rejections. Implement these recommended strategies:
Confirm coverage details before treatment to establish whether TMJ-related CBCT is included under the patient's dental or medical insurance.
Obtain prior approval when necessary, providing clinical records and detailed explanation of why the scan is medically required.
File claims with complete documentation, including analysis reports and patient notes.
For denied claims, submit appeals with supplementary evidence and references to established clinical standards for TMJ CBCT imaging.
Apply the appropriate CDT code—avoid replacing D0368 with alternative CBCT codes like D0367 (single view) or D0365 (facial region), which could lead to claim denial.
Precise coding practices and comprehensive documentation form the foundation for successful reimbursement and adherence to insurance requirements.
Clinical Case Study for D0368
Patient Scenario: A 32-year-old individual reports ongoing jaw discomfort, restricted mouth opening, and noticeable joint sounds. The treating dentist identifies possible TMJ disc problems and requests a CBCT examination using two different jaw positions—closed and open mouth views. Imaging results show abnormal condyle positioning and fluid accumulation in the joint space. The dentist records all clinical observations, medical reasoning, and imaging findings in the patient chart, then submits D0368 billing with complete supporting documentation. Following pre-authorization procedures, the insurance company approves the claim and processes payment promptly.
This clinical example demonstrates the critical role of accurate code usage, detailed record keeping, and effective insurance coordination when billing for specialized diagnostic procedures like D0368.
FAQ
Can D0368 be billed together with other CBCT imaging codes during the same patient appointment?
Yes, D0368 may be billed with other CBCT imaging codes when separate and distinct imaging services are provided in the same visit. It's essential to apply proper modifiers to differentiate each service and maintain thorough documentation in the patient's record for every procedure. This approach helps avoid claim rejections due to apparent service duplication.
Does D0368 fall under dental insurance coverage, medical insurance coverage, or both?
D0368 coverage depends on the specific payer and policy terms. Certain dental insurance plans may cover CBCT imaging for TMJ when medically necessary, while others exclude this coverage. Medical insurance may sometimes provide benefits, particularly when the imaging relates to a medical diagnosis or treatment protocol. It's important to confirm benefits and obtain pre-authorization from both dental and medical insurance carriers prior to the procedure.
What should a dental practice do regarding patient costs when D0368 isn't covered by insurance?
When D0368 lacks insurance coverage, dental practices should notify patients beforehand about expected out-of-pocket expenses. Provide a detailed written cost estimate and review available payment alternatives or financing options. Clear upfront communication helps set appropriate patient expectations and minimizes potential billing conflicts.