A Picture is Worth a Thousand Dollars.

I’m sure you’re thinking, that’s not how the expression goes, but it does in the dental world! Let me give you two perspectives on why an intraoral camera should be a non-negotiable in your practice. My first perspective is from a clinician’s standpoint and the second from an insurance viewpoint. 

 

As a clinical hygienist, I had two main MUSTS in my operatory at all times; One being my loupes and the second, an intraoral camera. Loupes allowed for me to give better patient care, helped with career longevity, and increased my overall productivity. Simply said, they made my job easier and the appointment more enjoyable for everyone. Although,when it came to explaining treatment to my patient, I’d take all of the help I could get! I prided myself on my communication skills, but the English language is pretty limited when trying to explain a fracture running along the distal cusp due to a failing faulty existing restoration to a patient. They may nod their head and say they understand why they need a crown, but do they really? If it doesn’t hurt, then surely it can’t be that bad, right? I bet if you analyze your treatment acceptance rate, you’ll have your answer. Part of my job as a clinician was to educate my patients utilizing the tell, show, tell methodology. By snapping a picture and throwing it up on a screen and SHOWING them exactly what was going on in their mouth and allowing them to see what I saw was huge! It was the “ah ha” moment where I could connect the full conversation and gain their confidence in knowing the validity of the treatment, recommended by me and confirmed by my dentist. 

 

Not only is early detection key in saving costs regarding treatment, but it’s also pivotal in reducing pain and spotting suspicious (sometimes life saving) lesions. Most patients, after viewing intraoral pictures of their teeth and gums, agreed with the necessity of the recommended treatment. Then came the next most commonly asked questions, “Will my insurance cover it?” and the answer every single time should be, “YES!” (as long as it is a covered benefit within their plan). As we know, that isn’t the case. Since my time with Dental ClaimSupport, I have seen this happen time and time again. 

 

The most common procedure code denial I have seen is D2950 (core build up) and D2740 (crown) when a fracture is present. Example: Tooth #30 presented with recurrent caries and a large crack on the distal surface around the existing amalgam.  A claim was submitted, reviewed, and denied due to necessity. You’re probably thinking, “How can that be? I sent them everything required! My patient clearly needed this treatment!” Well, if you sent in a radiograph with a narrative; you didn’t give the dental consultants with the insurance company the opportunity to actually “see” the fracture. We all know most fractures and sometimes decay, depending on the surface of the tooth, are not evident on radiographs; so to the insurance company, they don’t have sound proof of what you said you observed clinically was existing . It’s a shame, but insurance companies are cynical by default, to benefit themselves and preserve as much money within their organization as possible. Cue intraoral imaging! Although not required by most plans*, if you submit an intraoral photo with the fracture/decay circled and a narrative that clearly supports the treatment needed, 9 times out of 10, they will process it upon initial submission. If not, you have a much better case for yourself when appealing the initial denial, due to the fact that intraoral images leave little room for doubt. As a company, we do it all the time and LOVE receiving the letters back from insurance companies stating they have reconsidered their initial decision and have reprocessed the claim for payment. The practice wins, the patient wins, and Dental ClaimSupport wins. 

 

If there is one thing I’m passionate about within my organization and my time as a hygienist, it is making sure I do everything in my power to fight for patients’ rights. Their right to understand the overall condition of their mouths, their right to make educated decisions about their treatment, and their right to utilize their insurance benefits for necessary treatment. This is hands down a win-win for all parties involved. If you’re not utilizing intraoral imaging in your practice, I highly suggest you make the investment and reap the full circle of benefits. Fight for your patients and your practice. If you’d like our help, we’d be more happy to fight for you too. 

 

PS- be sure to dry the area/teeth before snapping the picture. It’s hard to see detail through spit bubbles :) 


*We have actually seen now where some Aetna plans require an intraoral image of build ups prior to seating the crown. If not available, they are denying the build up.

 

-Kelly Sullivan, RDH

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