Anyone else seeing plans deny four adult bitewings unless we document a caries-risk level? Since 1/1, about half our claims get down-coded to two unless the note spells out moderate/high risk and the last FMX date; we’re revising templates and want wording that’s clearing on first pass.
Since 1/1 we stopped getting down-coded by dropping a smart phrase in the rad note that spells it out: “CRA: D0603 (high); 4 BWX indicated for proximal surveillance; last FMX: 05/2023,” and it’s cleared first pass with most plans. Small caveat: a couple carriers still cap at two if the interval’s under 12 months even with “moderate/high risk.” Are you on Open Dental or Dentrix so I can share the exact template?
, same since 1/1 — plans bump D0274 to D0272 unless we spell it out. We made CRA a required picklist (D0602/3) and auto-push the level plus last FMX date into the claim narrative/NTE, and we also submit D0603 on the same day; since then, no down-codes; ADA backs individualized intervals: https://www.ada.org/resources/ada-library/oral-health-topics/radiographic-examinations. Caveat: truly low-risk we just send two to avoid appeals — anyone getting four paid without adding the CRA code?