Document with photography

April 1, 2002
Radiography depicts that which cannot be seen with the naked eye, while photography documents that which can be seen.

By Tom Limoli, Jr.

Radiography depicts that which cannot be seen with the naked eye, while photography documents that which can be seen.

Why use photographs?

Dental photography frequently is overlooked, yet it is a necessary key to third-party reimbursement. The dental team sees the patient face to face, and the patient can see the clinical condition in the video monitor or hand mirror. But how can the third- party payer see the patient?

Ever since the caveman began drawing on walls, it has been widely acknowledged that "a picture is worth a thousand words." Nowhere is this truer than in dentistry. Diagnostic photography documents that which radiology fails to confirm.

Fees for photographs

Consider an appropriate fee when billing for diagnostic photography. Various fee databases confirm that oral/facial images (D0350) have the same relative value (RV) as do four bitewing (D0274) radiographs. In other words, your office fee for four bitewings might very well be the same as that for a diagnostic photo. This is a critical component to a well-balanced fee schedule.

Third-party benefit plans rarely provide reimbursement for diagnostic photographs unless they confirm that which can't be seen in the traditional radiograph.

Coding diagnostic photographs

Prior to the release of CDT-3 (Current Dental Terminology), diagnostic photographs were identified using code 00471. When submitting a diagnostic photograph for benefit- plan reimbursement, consider using the redefined CDT-3 procedure code D0350. This code is defined as oral/facial images (including intra- and extra-oral images). Diagnostic pictures fitting this description include both traditional photographs and images obtained by intraoral cameras. These images should be part of the patient's clinical record. D0350 excludes conventional radiographs.

Narratives with photographs

The American Dental Association does not identify D0350 as a "by report" procedure code, but we at Atlanta Dental Consultants recommend that a brief narrative be attached to the claim. The intent of the narrative is simply to direct the benefit payer to the specifics of the clinical condition in question. Confirm to the plan administrator that the condition being treated is, in fact, a liability for payment under the terms of the benefit plan.

When diagnostic photographs are submitted for reimbursement, a short and simple narrative should support your findings. An example of such a narrative might be:

"The enclosed radiograph fails to show the ________________ ."

"The enclosed photograph shows the _______________________ that is not seen in the radiograph."

Photographs with the claim

Electronic-attachment software acquires digital images of intraoral photographs, which then are encrypted (meeting HIPAA requirements) and electronically transmitted to the attachments clearinghouse via the Internet. The clearinghouse then assigns it an identification number to transmit back to the dentist. The dentist enters the identification number into the "remarks" section of the electronic claim that accompanies the attachment. Next, the dentist transmits the claim through his or her claims clearinghouse. The claims clerk will see the identification number on the claim and go to the clearinghouse's secure Web site to retrieve the image.

Digital cameras are a perfect way to transmit intraoral photographs, since they are easily downloadable and can be sent over the Internet. Scanners with transparency adapters can transmit other types of attachments, particularly radiographs.

Typically, paper claims with attachments cost about $5 to $8 each. Multiply this by the number of times you mail claims with attachments each month to determine your monthly cost. Compare that monthly cost to the cost of submitting claims and attachments electronically. The typical flat monthly fee for sending attachments electronically is $15, regardless of the number transmitted.

Offices usually pay 50 cents per electronic claim, regardless of the claims clearinghouse used. Send three claims with ents per month electronically, and you're already saving money. The savings – in addition to the convenience of retaining your original images, the speed of electronic-claims processing, and the security of the identification number for tracking purposes – makes electronic claims and attachment submission a wise choice.

Photographs for the patient

The budgeting and financing of dental treatments often are challenging for both the dental office and the patient. Do not ignore the patient's budget. In many instances, your patient is not the sole financial decision-maker. Individuals who are not in the dental profession can easily understand photographic documentation of failed restorations or other clinical conditions; radiographs can be too confusing Consider the impact of including several diagnostic photographs for the patient.

Never overlook both the clinical and administrative benefits of diagnostic photography!

When to supplement photographs with radiographs

Diagnostic photographs can be invaluable when:
• X-rays do not support the clinical observations.
• A visual record of the patient's periodontal condition is needed for claims submission or consultation purposes.
• Bleeding on probing is present with no radiographic evidence of bone loss. Full-blown, marked gingivitis can only be documented photographically.
• A deep periodontal crater is visible and photographed after a flap opening. When the periodontal chart was being made, the probe hung on a ledge, giving false indication of a much shallower pocket depth, and the X-ray did not confirm it.
• Pretreatment records for adult orthodontics must always include diagnostic photographs.
• Diagnostic photographs provide accurate documentation of the preoperative condition. Documentation is needed to monitor treatment progress for potential legal reasons or possible questions by a third-party payer.

Tom Limoli Jr. is the president of Atlanta Dental Consultants and the editor of Dental Insurance Today, a bimonthly publication that addresses third-party reimbursement in the dental office. He also is the author of Dental Insurance and Reimbursement Coding and Claim Submission. He can be contacted by phone at (404) 252-7808. Visit his Web site at

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