If 4 bitewings and 3 pa-s are taken on the same visit, is this the right coding: D0274-D0220-2xD0230? A Billing Auditor pointed out today, the proper coding would be D0230 used 3 times. His explanation was: bitewings are considered as first radiographic images, so D0274 and 3xD0230 would be the proper way to bill. Our office believes the right way of coding is: D0274-D0220-2xD0230 Please help us with a brief explanation which way is the proper way to code.

If 4 bitewings and 3 PA's are taken on the same visit the appropriate way to code this visit would be the following:
D0274 x 1 (bitewings- four radiographic images)
D0220 x 1 for the 1st PA (periapical first radiographic image)
D0230 x 2 for the additional 2 PA's taken (periapical each add image)

Your billing auditor is incorrect, bitewings would not be considered a first radiographic film. A bitewing is just that a "bitewing" meaning in many cases it does not expose the entire root tip which is needed to be considered a periapical film. Bitewings are a different type of x-ray and have their own code for a reason.

For more information on x-rays and usage guidelines please refer to the utilization review guidelines published by CMS and Delta Dental.