Radiographic Frequency: It’s Not Simply About the Calendar
Dental Insurance Today — August 2018
How often does your office update radiographs? Is it based upon specific, doctor-diagnosed patient need or their individual benefit plan limitation? Be honest with yourself as well as both your clinical and administrative teams. Do patients question radiographic frequency to the extent that they only want them if paid for by their insurance? Now here is the kicker — do you write off the fee if the plan doesn’t pay? Ouch!
Dental Radiographic Examination: Recommendations for Patient Selection and Limiting Radiation Exposure is the authoritative source on the appropriate sequencing of dental x-rays. It is a joint publication of the American Dental Association, Food and Drug Administration, and the U.S. Department of Health and Human Services. Its current revision is 2012. Our Canadian counterparts have a similar publication from their Royal College of Dental Surgeons: Information on Dental Radiographs for Dentists. Both publications embrace, as well as direct, the dentist to clinically examine the patient prior to prescribing radiographs.
For those not familiar with the FDA criteria, allow me to share with you two of the more frequently referenced citations from the publication:
Page 1, Paragraph 2
“The guidelines are not substitutes for clinical examinations and health histories. The dentist is advised to conduct a clinical examination, consider the patient’s signs, symptoms and oral and medical histories, as well as consider the patient’s vulnerability to environmental factors that may affect oral health. This diagnostic and evaluative information may determine the type of imaging to be used or the frequency of its use. Dentists should only order radiographs when they expect that the additional diagnostic information will affect patient care.”
Page 3, Bullet Point 3
“Radiographic screening for the purpose of detecting disease before clinical examination should not be performed. A thorough clinical examination, consideration of the patient history, review of any prior radiographs, caries risk assessment and consideration of both the dental and the general health needs of the patient should precede radiographic examination.”
As for the Canadian criteria, their publication appears in a somewhat friendlier question/answer format. One of their most frequently referenced citation is:
Page 3, Paragraph 2
“Can a dentist provide a standing order for radiographs to be taken at recall appointments?”
“No. The taking of radiographs requires a patient-specific prescription. However, a dentist can prescribe radiographs for a specific patient to be taken at a subsequent appointment in order to follow up on a previously detected condition/pathology, or if the anticipated information may aid in confirming a diagnosis or evaluating treatment provided. The dentist should document the prescription for future radiographs in the patient’s chart.”
Please be cautiously aware with both the administrative as well as clinical workflows when dealing with radiographs. Administratively, are you wasting valuable employee time determining if a particular radiographic survey is a payable benefit before the doctor even determines which image(s), if any, are going to be clinically prescribed? Is the doctor’s diagnosis or the benefit plans frequency limitation determining when images are updated?
Of greater concern is the true root of the problem. Are radiographs being taken before the doctor even evaluates the patient?
So what is your answer?
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YES. For 30+ years we’ve been taking X-rays prior to the Dr. Exam. This way the updated images are available for the Dr. to review upon entering the hygiene room. This also prevents the Dr. from having to come to the hygiene room twice (and leave their own treatment room/patient).
YES, we have historically taken the x-rays “allowed” by the dental plan frequency and/or limitations. X-rays have been an integral part of providing a thorough clinical evaluation.
Without xrays we can’t do a proper cancer screening therefore new pts always and at least every 5 years. People don’t need to die so the ins co ceo puts a few more $ in his pocket.
The issue at hand is not the radiographic necessity but rather its frequency. Does the doctor or the benefit plan determine the necessity in your office? The FDA criteria make it clear.