Plan Stipulations vs. Patient Needs: D0330, D0272, & D0251

Navigating the ever-evolving CDT code set can sometimes feel a lot like, well… pulling teeth. Whether you’re billing for a simple prophy or a complex full-mouth reconstruction, coding correctly protects your bottom line from the decay of insurance delays, or worse – denials. You should always code for what you do. However, applying that “rule” to the messy, real-world nuances of a busy dental practice is oftentimes easier said than done.

Take radiographs, for example. If you have a patient with a highly sensitive gag reflex, an overly small mouth, or lingual tori in your chair, suddenly a standard image capture requires a bit more creativity than expected to achieve. An example of this would be obtaining an approximation of bitewings after an image was captured on a panoramic machine with a special bitewing mode.

In this situation, what code do you use?

A key distinction under the CDT, is that bitewing radiographs, unlike periapical radiographs (D0220 & D0230) or an intraoral – comprehensive series (D0210), are not required to be captured intraorally. This distinction is vital when faced with a patient who simply cannot tolerate traditional xray sensors. In keeping with the principle of always coding for what you do, it is essential to understand which CDT code to report when using a panoramic machine to obtain bitewings when you cannot obtain them traditionally. 

We often see two common – but very different – approaches for this:

• A Panoramic Radiographic Image (D0330) used by offices focusing on the equipment used to capture the image, or
• Bitewings – Two Radiographic Images (D0272) used by offices focusing on the clinical result of the image taken.

Choosing the correct code is not just about getting paid based on plan stipulations; it’s about maintaining an accurate clinical record and staying compliant with the latest CDT guidelines and coding changes.

To address this scenario, a CDT code was added to specifically describe posterior radiographic images obtained extraorally.

To ensure the most accurate and specific code reporting possible, when posterior bitewing images are taken with a panoramic or CBCT in dedicated bitewing mode, Extra-Oral Posterior Radiographic Image (D0251) was added to the code set. This most accurately reflects the type of image that shows an exposure of complete posterior teeth in both dental arches. Even with this addition, one big question still remains:

Will a payor reimburse me for this code?

The answer to this question is hardly ever straightforward. When reporting this code, it is best to include a narrative stating the necessity (i.e. patient unable to tolerate intraoral sensor due to gag reflex). Additionally, include verbiage that if D0251 is not benefited, consider the alternate benefit of Bitewings – Four Radiographic Images (D0274). When benefited, D0251 has a higher reimbursement than the corresponding bitewing codes. As a final note, if both sides are captured this way, report D0251 with a quantity of two on the 2024 ADA Dental Claim Form when submitting to the payor; once for the right side, and once for the left side.

Ultimately, the goal is to bridge the gap between clinical necessity and administrative accuracy. The most important thing to remember is that while dental plans are built on rigid stipulations, clinical care should be built on the unique needs of the patient sitting in your chair. When a patient’s specific needs require you to deviate from the typical treatment standard, you shouldn’t have to choose between treatment necessity and the potential for payor reimbursement. The goal is to ensure that “the way it’s always been done” never stands in the way of “the way the patient needs it done today.”