Can you Use a Panoramic for Bitewings or is it Fraud?

by: Will McGowan, Compliance Coach

During a recent compliance records audit, I encountered something that I had never seen before.  It appeared to me as a panoramic x-ray, sliced in half, considered bite wing x-rays and billed out as bite wing x-rays.  My first inclination is that they can’t bill an intraoral x-ray as a bite wing x-ray.  I’ve been associated with the dental profession for years and I know a bite wing x-ray when I see a bite wing x-ray and this wasn't one.  Or was is? 

After speaking to the doctor about what I’d found, he informed me that they had been using this method for several months and had been getting paid for the service when billed.   I reminded him that  just because the insurance company paid on the service, doesn’t mean they won’t recoup after retrospective review later. Since we are always covering new ground in this industry, we decided it warranted further review!  After leaving the office, I conducted my own research to see how this practice related to TSBDE, Medicaid and CHIP standard, policy and procedure.

Are you wondering what I learned in my research?  Well, there is actually new technology that has resolved how to open the posterior dentition and obtain a panoramic bitewing.  After conferring with a couple of Medicaid DMO’s who process and pay Medicaid and CHIP claims, I learned that their view on the matter is as long as the radiographs are diagnostic, the interproximal surfaces are visible, and the dental professional is not expecting more than what’s posted in the Medicaid and CHIP programs fee schedule, these pano produced bite wing x-rays are acceptable.  The TSBDE has not yet made a ruling this method regarding standard of care. 

Proponents for using the panoramic x-ray machine to produce bite wing x-rays say that this process has less radiation exposure, less infection control, is a faster process and is beneficial when treating an un-cooperative child patients or a patients with an overactive gag reflex. I learn something new every day- and that's a good thing. I really enjoy being able to the tell our clients, "Yes, you can!"