Understanding Dental Code D0386

When to Use D0386 dental code

The D0386 dental code is designated for the capture of maxillofacial ultrasound images. This CDT code is specifically used when a dental provider performs and captures an ultrasound image of the maxillofacial region, which includes the jaw, facial bones, and associated soft tissues. Unlike traditional dental radiographs, ultrasound imaging is non-ionizing and can be particularly useful for evaluating soft tissue lesions, cysts, or other abnormalities that may not be visible on X-rays. Use D0386 only when the ultrasound is performed as a diagnostic tool and the images are captured for clinical evaluation or treatment planning.

Documentation and Clinical Scenarios

Proper documentation is essential when billing for D0386. The clinical notes should clearly state the reason for the ultrasound, the area imaged, and the findings or impressions. Attach the actual ultrasound images to the patient record, and ensure that the provider’s interpretation is included. Common clinical scenarios for using D0386 include:

• Assessment of soft tissue swellings or masses in the oral and maxillofacial region
• Evaluation of suspected cysts or abscesses
• Pre-surgical planning for implant placement or other oral surgeries
• Monitoring of known lesions or post-surgical healing

Always document the medical necessity for the ultrasound and reference any supporting diagnostic codes (ICD-10) in the patient’s chart.

Insurance Billing Tips

Billing D0386 can present unique challenges, as not all dental insurance plans routinely cover ultrasound imaging. To maximize reimbursement and minimize denials, follow these best practices:

• Verify coverage: Before performing the procedure, check with the patient’s insurance to confirm if D0386 is a covered benefit. Document the verification call or portal check in the patient’s record.
• Submit detailed claims: Include a clear narrative explaining the clinical necessity, attach the ultrasound images, and reference any related procedures (such as comprehensive oral evaluation or diagnostic casts if performed).
• Review EOBs promptly: If the claim is denied, review the Explanation of Benefits (EOB) for the reason code. If the denial is due to lack of documentation or medical necessity, submit a claim appeal with additional clinical notes and supporting evidence.
• Train your team: Ensure that your front desk and billing staff are familiar with D0386 and know how to explain its value to patients and payers.

Example Case for D0386

Consider a patient presenting with a persistent swelling in the lower jaw. The dentist suspects a soft tissue lesion that is not clearly visible on a panoramic radiograph. The provider performs a maxillofacial ultrasound, capturing images that reveal a cystic structure. The findings are documented in the patient’s chart, and the images are attached to the record. The claim for D0386 is submitted with a detailed narrative, the ultrasound images, and the relevant ICD-10 code for jaw swelling. After initial denial for lack of documentation, the office submits an appeal with additional clinical notes and receives payment upon review.

This example highlights the importance of thorough documentation, proactive insurance verification, and diligent follow-up in successfully billing for D0386.