Understanding Dental Code D0368

When to Use D0368 dental code

The D0368 dental code is designated for the cone beam computed tomography (CBCT) capture and interpretation for temporomandibular joint (TMJ) series, including two or more exposures. This code should be used when a dental provider performs a CBCT scan specifically to evaluate the TMJ, capturing at least two exposures to provide a comprehensive view of the joint’s anatomy and function. D0368 is not appropriate for single-exposure CBCT scans or for CBCT imaging unrelated to TMJ assessment. Proper use of this code ensures accurate clinical documentation and reimbursement for advanced diagnostic imaging services related to TMJ disorders.

Documentation and Clinical Scenarios

To support the use of D0368, dental practices must maintain thorough documentation. This includes:

• Detailed clinical notes describing the patient’s TMJ symptoms (e.g., pain, clicking, limited opening).
• Rationale for ordering the CBCT scan (e.g., suspected internal derangement, pre-surgical planning, or evaluation of trauma).
• Interpretation report by the dentist or radiologist, detailing findings from two or more exposures.
• Images stored in the patient’s chart for reference and audit purposes.

Common clinical scenarios for D0368 include patients with chronic TMJ pain, suspected joint pathology, or those requiring pre-orthodontic or pre-surgical evaluation. Always ensure that the medical necessity for the scan is clearly documented to support insurance claims.

Insurance Billing Tips

Billing D0368 correctly increases the likelihood of reimbursement and minimizes denials. Follow these best practices:

• Verify insurance benefits prior to the procedure to determine if CBCT for TMJ is a covered benefit under the patient’s dental or medical plan.
• Pre-authorize when required, submitting clinical documentation and a narrative explaining the medical necessity for the scan.
• Submit claims with supporting documentation, including the interpretation report and clinical notes.
• If denied, appeal claims with additional documentation and reference to current clinical guidelines supporting CBCT use for TMJ evaluation.
• Use the correct CDT code—do not substitute D0368 with other CBCT codes such as D0367 (single exposure) or D0365 (maxillofacial area), as this may result in claim rejection.

Accurate coding and robust documentation are essential for successful claims and compliance with payer requirements.

Example Case for D0368

Case Example: A 32-year-old patient presents with chronic jaw pain, limited mouth opening, and audible clicking. The dentist suspects internal derangement of the TMJ and orders a CBCT scan with two exposures—one with the mouth closed and one open. The scan reveals condylar displacement and joint effusion. The dentist documents the clinical findings, rationale, and interpretation in the patient’s record, then bills D0368 with all supporting materials. The insurance claim is approved after pre-authorization, and the practice receives timely reimbursement.

This example illustrates the importance of proper code selection, thorough documentation, and proactive insurance communication when billing for advanced diagnostic imaging like D0368.