Understanding Dental Code D0350

When to Use D0350 dental code

The D0350 dental code is designated for the acquisition of 2D oral/facial photographic images, whether obtained intra-orally or extra-orally. This CDT code is typically used when photographic documentation is necessary to supplement clinical findings, support a diagnosis, or provide evidence for insurance claims. Common scenarios include documenting soft tissue lesions, pre- and post-treatment conditions, traumatic injuries, or orthodontic progress. It is important to note that D0350 should not be used for radiographic images, as those have separate CDT codes.

Documentation and Clinical Scenarios

Proper documentation is essential for the successful use of D0350. Dental teams should ensure that each photographic image is clearly labeled with the patient’s name, date, and a brief description of what is being documented. Clinical scenarios where D0350 is appropriate include:

• Recording the appearance of suspicious oral lesions for referral or biopsy
• Capturing pre-treatment and post-treatment images for cosmetic or restorative cases
• Documenting traumatic injuries for insurance or legal purposes
• Tracking orthodontic progress or appliance fit

Images should be stored securely in the patient’s electronic health record (EHR) and referenced in the clinical notes to justify their necessity.

Insurance Billing Tips

When billing for D0350, it’s crucial to verify each patient’s insurance policy to determine if photographic images are a covered benefit. Many payers consider D0350 a “supporting” code, meaning reimbursement may depend on medical necessity and the presence of a related primary procedure. Best practices include:

• Insurance Verification: Confirm coverage for D0350 during the insurance verification process. Document the payer’s policy in the patient’s file.
• Claim Submission: Always submit D0350 alongside the primary procedure code it supports (e.g., periodic oral evaluation or surgical extraction), and include narrative documentation explaining the need for photographic images.
• Explanation of Benefits (EOB): Review EOBs carefully. If D0350 is denied, check if additional documentation or a claim appeal is warranted.
• Appeals: If necessary, submit a detailed appeal letter with annotated images and clinical notes to demonstrate medical necessity.

Accurate, thorough documentation and proactive communication with payers can improve the likelihood of reimbursement for D0350.

Example Case for D0350

Consider a patient presenting with a suspicious white lesion on the buccal mucosa. The dentist takes intra-oral photographs using a digital camera to document the lesion’s size and appearance before referring the patient for a biopsy. The images are saved in the patient’s EHR, and a detailed clinical note is entered describing the lesion and the rationale for referral. When submitting the claim, the office bills D0350 in conjunction with the examination code, includes a narrative about the lesion, and attaches the images if the payer allows. This thorough approach supports the claim and demonstrates the clinical value of the photographic documentation.