Thursday, June 05, 2008

Insurance codes for i-CAT

Dr. Trevino from Pacific Dental Imaging just called me and inquired about the proper insurance codes for the i-CAT. This is what I currently have for cone beam CT:

Current Dental Terminology (CDT) codes:

DO360 cone beam ct-craniofacial data capture:includes axial, coronal and sagittal data.

DO362 cone beam - two dimensional image reconstruction using existing data, includes multiple images.

DO363 cone beam- three dimensional image reconstruction using existing data, includes multiple images.

Notice that code DO360 is described as data capture while DO362 and DO 363 is considered reconstruction. Which procedure codes does your facility use for the i-CAT? Do you use one, two or all three of the codes for the i-CAT?

What code(s) do you use for TMJ? Do you use the cone beam code ( if so, which one?) or the DO322 tomographic code or DO321 other temporomandibular joint films, by report? DO320 is temporomandibular joint arthograms including injection, so that doesn't work.


Blogger Rocky Mountain Oral X-ray said...

We are still using old codes for tomography because our (Colo) Delta insurance does not cover ANY of the new CBCT codes on any of their policies. My reasoning is at least some people get covered on the old codes. I did receive a Metlife Table of Maximum Allowable Charges (which are specific to my zip code). They allowed:
D0360 Capture $385
D0362 2D reconsturction $231
D0363 3D reconstruction $308

I was pretty pleased with this! My question is: If I do a capture, 2D image report, & 3D movie (or just provide icat Vision with 3D capability), would you bill for all 3 codes? That's what it seems like to me. I'm not sure how to go about this with the insurance companies. I think this will be a slow acceptance by them because of the cost. Marcelle

7:17 AM  
Blogger colleen said...

We use old tmj codes for the tmj films, only because the insurance companies will usually reimburse for that one.

We only use the D0360 for all other scans and all formats are included in that fee.

We received max allowable charges from MetLife:
D0360 $385
D0362 $231
D0363 $308

We were surprised too, but we get so many complaints at just the scanning fee, we haven't billed these codes. Anyone else???

12:22 PM  

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