FYI

Some endodontic procedure codes require the submission of documentation with Delta Dental PPO™ and Delta Dental Premier® claims. Let’s review radiographic image requirements for these procedures and the associated denials that can occur.

When are radiographs required?

Pre-operative and post-operative periapical radiographs are required when submitting endodontic procedures D3310 through D3330 and D3921. All radiographs, including working radiographs, should be maintained in the patient treatment record. Pre-operative periapical radiographs must be submitted with pre-treatment estimates, and both pre-operative and post-operative periapical radiographs must be submitted with claims upon completion of procedures.

What do correct radiographs look like?

The following radiographic images correctly depict an acceptable pre-operative and post-operative periapical x-ray of completed root canal therapy on tooth #18.

What do correct radiographs look like?

The following radiographic images correctly depict an acceptable pre-operative and post-operative periapical x-ray of completed root canal therapy on tooth #18.

In this second example below, the radiographic images correctly depict an acceptable pre-operative and post-operative periapical x-ray of completed root canal therapy on tooth #19.

In this third example, the radiographic images correctly depict an acceptable pre-operative and post-operative periapical x-ray of completed root canal therapy on tooth #11.

What do unsuitable radiographs look like?

The following radiographic image fails to depict completed root canal therapy on tooth #18. Submitted post-operative periapical radiographs must depict the completed root canal.

Working radiographs (x-rays used to confirm the root length) and gutta percha fit radiographs (x-rays used to confirm the root canal material extends to the appropriate length) may be submitted as pre-operative periapical x-rays.

However, they are unacceptable when submitted as post-operative periapical x-rays, as they fail to depict the completed root canal.

The following radiographic image fails to depict the entire, completed root canal therapy on tooth #31. The final endodontic x-ray must depict the apex. 

Bitewing and other radiographs that do not depict the apex of the tooth are inadequate, as the placement, density and depth of the root canal filling material cannot be fully evaluated.

What codes accompany endodontic claim denials?

If your endodontic claim is denied, you may see one of the following denial codes:

• 570. Benefits could not be determined because of missing pre-operative periapical radiographic images.
• 5L8. Benefits could not be determined because of missing pre-operative periapical radiographic images.
• FMW. Benefits could not be determined because of missing pre- and post-operative periapical images.
• 8L9. Benefits could not be determined because of missing post-operative radiographic images of completed root canal therapy.
• 5RX. Benefits could not be determined, because the submitted radiograph does not depict the entire tooth.
• 569. Benefits could not be determined because of the non-diagnostic nature of the radiographic images submitted.

To expedite the processing of your claim and to ensure timely benefit determination, always submit the appropriate mounted and dated x-rays and supporting documentation on your initial submission. Enter the required documentation information in the Remarks or Comments field of the claim.

Please do not submit original radiographic images if they are the only diagnostic record for your patient. Duplicate radiographs or radiographic image copies of diagnostic quality, including paper copies of digitized images, are acceptable. We do not return radiographic images or other documentation submitted with paper claims; however, we will make an exception when we receive a stamped, self-addressed envelope with the claim.

CDT coding and nomenclature are the copyright and a trademark of the American Dental Association, all rights reserved.