Fast Facts: Coding Episode 12
[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. My name is Teresa Duncan with Odyssey Management, and I am going to go over D0210 today. D0210, that's your FMX code. I know that you knew it, and we were like, I know that code! It's your FMX code. You just see it on the ledger all of the time. There's going to be a change starting 2023 there's going to be a change in the descriptor of 210, and I wanted to make sure that we went over that.
Now, last coding, Fast Facts, we talked about why radiographs need to have medical necessity, a reason why you took the radiograph and then also has to have proof of the fact that you reviewed the radiograph and noted any findings. So with D0210, that's not any different. We need to make sure that we have some sort of indication of why we need it. So first things first. Patient comes in for a new evaluation, new visit, and what you need to do, of course, take films so that you can do an accurate evaluation, a comprehensive evaluation. Well, when offices have it set on automatic, where all new patients get FMX, that becomes problematic. It's the same thing as where every office says we need bitewings every year, no matter what on our patients, at least once a year.
So what you've just done is made some blanket statements about the health of your patients. So radiographs do need to be specific to the patient's condition. Go back and listen to the previous coding, Fast Facts with me, and I'll go more into detail about that. So D0210, as you know, it basically says that there is a radiographic survey of the whole mouth, and it should consist of 14 to 22 periapical and posterior bitewing images and it's intended to display the crowns and roots of all teeth, periapical areas, and alveolar bone. Okay, so that's the old one. That's what we're working with right now. Next year, this much simpler skimmed down version, slimmed down version is a radiographic survey of the whole mouth intended to display the crowns and roots of all teeth, periapical areas, interproximal areas, that's a new one and alveolar bone, including edentulous areas that's a new one too.
Okay, so what do they mean? Why did they do this, first of all? Well, they needed to be a lot more clear. There was a question of we can't take images on edentulous areas. Really? What about that? Well, you can and you should, because you still got to monitor bone height and all that and remember, I'm not a clinician. I'm just telling you what I've been told by lots of clinicians. But the most important change to me here is that they took out the 14 to 22 images. So now we just have a radiographic survey of the whole mouth. Now does that mean that it's 18 or 14 to 22 images? Maybe. Maybe in your office it is, maybe in your office it's not. Maybe it's 12. Maybe you just take four vertical bitewings and a couple PAs and it's maybe 15. So that's the problem is that the insurance carriers need to decide how they're going to pay on something that now is variable from office to office. Every doctor is going to have a different idea of what an FMX looks like for each individual patient and that is where the rub is.
Okay, so I wanted to let you know about the coding change that's coming up, the wording change on there, and what I worry about the most, because I'm your admin person that's upfront going, oh, how is this going to be paid? I worry that now that that 14 to 22 requirement is out, that carriers may take a look at your four bitewings and one or two PAs, or two bite wings and one or two PAs and assess that that was enough for them to pay out an FMX and then that frequency limitation applies. All right? So the other way is also something I'm concerned about, where they will go ahead and allow benefits for the FMX, but it will be much reduced. Okay, so what I mean is FMX will look like it's approved on your EOB, but because you took maybe six radiographs, counting the four bitewings and a couple PAs, let's just say that you did six or seven radiographs, okay? And because of the patient's mouth or whatever, you were able to get a pretty comprehensive set. I don't see how, I'm just kind of telling you how it's going to look. So in that situation, the 0210, they may take a look at that and go, yeah, but you know what, you didn't take as many films, so let's just go ahead and download that. And that's what I worry about, is that the 0210s are going to be sent in and if they asked to see the it's not 14 films, maybe you did it with twelve films.
They're going to go ahead and downgrade that to bitewings. That's what I worry about the most. So anytime there's a coding change of a very highly used code, like any of the diagnostic and preventive, I always sit up and think of all the weird ways that it could be processed and eventually it happened. So I'm trying not to manifest it, but sometimes it happens. So hopefully the 0210 is something that you can go back and discuss with your team about. Just be aware of the change. And then the biggest thing is have your insurance coordinator keep an eye out in 2023 on how FMX's will be processed. On my end, I always am reviewing the insurance company portals for their new processing policies. And so as soon as I see any movement in this area, I'll either blog about it or podcast about it. All right, my name is Teresa Duncan with Odyssey Management. Feel free to check out my website, odysseymgmt.com, for my other podcast and also for any online classes and until the next edition, I want to thank you for tuning in to your coding Fast Facts.
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 www.dentistrx.com. We'll see you next week for another Fast Fact!