D0220 is only for the first periapical (PA) radiograph taken on any date of service.
Report D0230 for each additional periapical radiographic image taken after the first image on the same service date.
Periapicals associated with an endodontic diagnosis on a date prior to definitive treatment are typically reimbursed. “Working and post-treatment” images associated with endodontic treatment are part of the global endodontic fee. Post-operative diagnostic images taken of the treated tooth within 30 days of the completion of a root canal are typically included in the global endodontic fee.
The type and sequence of diagnostic images should be determined and ordered by the dentist based on the patient needs. This determination is based on risk assessment, observation, and dental necessity. Images should not be taken based on the patient’s plan benefits or limitations. Patient documentation should contain the dentist’s written evaluation of the diagnostic images taken. If there is no documentation of the dentist’s radiographic evaluation in the chart, the payer may deny payment of the claim or ask for reimbursement in the event of an audit.
Enter the tooth number or range of teeth numbers being evaluated in Box 27 of the 2012 ADA Dental Claim Form.
Limitations
Periapical radiographic images at emergency visits are routinely reimbursed. However, periapicals at checkups may require a narrative and/or chart notes and the actual image (required more and more). A caries risk assessment demonstrating increased risk, if appropriate (D0602, and D0603) may help justify periapicals at a checkup taken in conjunction with bitewings. Several payers are cracking down on pariapicals being routinely taken with bitewings at a recall visit.
If a number of periapicals and bitewing radiographic images are taken on the same service date and the fee for those images is equal to or greater than the comprehensive series, the fee reimbursed will be limited to that of the comprehensive series. The payment of the comprehensive series will trigger the “once every three to five-year limitation.” If a comprehensive series is reimbursed, a notation should be made in the patient’s billing record for future reference.
Reimbursement for periapical images, if reported in conjunction with bitewing images, may be limited by some payers.
For intraoral – periapical radiographic image, image capture only, see D0707.
For intraoral tomosynthesis - periapical radiographic image see D0374. For image capture only, see D0389.
Tips
One, two, or three periapical images may be reimbursed on a problem focused evaluation (D0140) service date. Periapical images taken at the problem focused visit typically do not affect the “once per year/12 months” limitations for bitewing images associated with recall visits.
Intraoral periapical first image (D0220) and an additional periapical image(s) (D0230) are often payable at any visit (including recall), if medically necessary. At an emergency, problem focused oral evaluation (D0140) or periodic oral evaluation (D0120) recall visit, the periapical image reimbursement may be subject to a deductible as well as the maximum fee limitation for multiple diagnostic images.
Periapicals, particularly at different “angles,” are often necessary to provide alternate views of the anatomy of an area for a complete diagnosis. Two periapicals are a better choice at the emergency visit from a reimbursement perspective as well as from the clinical perspective. Billing a single bitewing at the emergency visit may prevent reimbursement of two/four bitewings at the recall visit.
