Worthless Radiographs, Exposure Hazard

July 2019
Admin/Record Keeping/Charting

Most dentists and dental hygienists are very particular about providing services considered acceptable by their peers, with potentially the following exception, radiographic images. When in dental school, or hygiene school, and assisting school, we are taught to take radiographs with the understanding there are various standards established for the different type of radiographic images captured. During that training, the instructors are unwavering when reviewing those images. If the image does not meet the standards set, that image must be retaken and the subsequent grade assigned affected. Proficiency must be established before an individual deemed capable of capturing images and the right to take radiographs given. After graduation, it is up to the dentist and team to maintain that proficient level.

In auditing the records for multiple patients in multiple practices, it has become clear that these standards are not always maintained. After charts are reviewed and radiographic images are assessed, many images are simply not clinically acceptable. There are images that are cone cut, poorly positioned, periapicals that do not capture the entire tooth including the apex, bitewings where the interproximal contacts are overlapped, etc. When checking to see if those images were billed, in almost every instance, they were. If that radiograph does not meet the standard of care, it is considered a worthless service and should not be billed to the patient nor to the patient’s dental plan.

What’s the big deal? If a payer conducts an audit and the radiographs reviewed, those radiographs should be clinically acceptable. If that image is less than acceptable, it results in a worthless, unbillable service. In an audit where 20 patient charts were reviewed with 13% of the radiographs found to be unacceptable, payers can use extrapolation to determine any reimbursement from the practice. The plan can go back 6 years and ask for 13% of all payments for radiographic images returned. There have been practices that have had to return thousands and thousands of dollars as a result of an audit that discovered multiple images that were billed, but were clinically unacceptable.

How do you prevent this potentially devastating situation from occurring? Establish and maintain radiographic image standards that are clearly understood. Only bill for services (radiographic images) that are clinically acceptable. Be careful to train and support team members so that all can produce consistently excellent images. If further education and training are necessary, provide it. The goal is for consistent excellence. Do not bill for radiographic images that are not medically necessary or clinically unacceptable.

It is important to remember that all radiographs should be ordered by the dentist based on the individual need of each patient. The documentation should include that the dentist ordered the radiographs, the rationale for the radiographs, and that the dentist read the images and the findings or lack thereof.

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