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Fast Facts: Coding Edition - Radiographs

Fast Facts

Fast Facts: Coding Episode 11

[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Coding Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Teresa Duncan, MS.
[Teresa Duncan, MS]
Hello, and welcome to this edition of your coding, Fast Facts. Today I would like to talk to you about a group of codes in general, not necessarily one or two. Let's talk about radiographs. So you're thinking, okay, this is pretty boring, but radiographs can get you into some trouble. And they're helpful, we know that, but they can get you in trouble if they're being used in the wrong way. Now, also getting into trouble means the documentation that goes along with radiographs is not present and found in your notes. And that really is the biggest issue. And so let's go into more of a meta conversation about radiographs and how to keep yourself out of the crosshairs of any insurance audits.
Let's talk about this. What are radiographs? Honestly, they're X rays. They're images. We get that, right. But when I'm talking about items that need to be prescribed, if you look into the practice act of your state, if you look into the CDT code, most images, almost all of them, are needing to be prescribed in order to be taken. So you don't just have a patient come in as a new patient and you just take an FMX on them because that's what you always do.
The reason being is that there has been an overabundance of radiographs that are taken. They're still being taken. The ADA and the FDA, the Food and Drug Administration, have actually come up with a list of guidelines that really go over when is it appropriate to take a radiograph, when is it not. And what it all comes down to and I know this isn't going to surprise you it all comes down to risk factors. It comes down to a risk assessment. The classic example I always give in classes is, what about the patient who has never had a restoration? She flosses, brushes, no risk factors, no smoking, nothing. If she comes in every year, do you need to take bitewings? Sometimes, and many of you will realize, no, you know what? It's immaculate. I don't need to take bitewings every year, maybe every two years. But you have somebody who comes in and they're a big Mountain Dew drinker and they smoke, that person is going to need X-rays on a much more frequent basis. And so when I say that X-rays should be prescribed, it's because it really is an individual risk assessment driven discussion that you have to have.
Now, yes, when the patient comes in for their first appointment, you want to get a complete radiographic history of them, right? But you have to have something in the notes that indicates that you've prescribed it. So you could put in something very simple such as radiographs required due to just remember that phrase and add that into your notes, radiographs required due to and then, depending on what you see, it could be to assess the patient's oral condition. That's appropriate for an initial evaluation. What about returning to monitor a patient's health, to monitor crown on the upper left. I mean, there's lots of ways that you can fill this out. You have the information. It's just a matter of adding it in as documentation. And that's always the painful part, right? Like getting what you know and sticking it into the notes so that it can be archived, for posterity. So medical necessity is what we call this.
And the second part is, what on earth did we do with the information once we read it? And so radiographs required "due to", is a good thing to have. And then the next piece is "radiographs reviewed".
So if you take radiographs, "radiographs reviewed" should be in your notes as well, because the first part of the codes means that you assessed and took the radiographs. The second half of the codes is that somebody reviewed them. And so there's two components, right? If you think about it, why take an Xray and not have it be reviewed? So it makes sense to us, but unfortunately, we need to make sure it's spelled out documentation wise. And this isn't even an insurance thing. I don't want you to ever have to go in front of a jury of your peers, and they won't be your peers because they won't understand dentistry and have to defend your clinical discussions. Okay, so let's bring the temperature down a little bit, because I don't want you to think that every case is going to be a fraud case or an audit case but specifically, there are those requirements that you need to prescribe the radiograph and review the radiograph.
All right, until your next coding Fast Facts. My name is Theresa Duncan. I am with Odyssey Management. Feel free to check out my website, for more podcasts and for more coding information and classes. Thank you so much.
Thank you for listening to another episode of Fast Facts -  Coding Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at We'll see you next week for another Fast Fact!

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