Understanding Dental Code D0391

When to Use D0391 dental code

The D0391 dental code is designated for the interpretation of a diagnostic image by a practitioner who was not involved in capturing the image. This CDT code is most commonly used when a dental office refers a patient’s radiographic image (such as a panoramic X-ray or cone beam CT) to an outside specialist for a second opinion or expert interpretation. It is important to note that D0391 is not for the technical performance of taking the image, but strictly for the professional interpretation and report by a different provider. Use this code when:

• A general dentist sends a CBCT scan to an oral radiologist for interpretation.
• An orthodontist requests a formal report from a radiology specialist on an image taken in another office.
• A patient brings previous images from another provider, and your office requires a specialist’s interpretation.

Documentation and Clinical Scenarios

Proper documentation is critical for successful reimbursement and compliance. When billing D0391, ensure your clinical notes include:

• The date and type of image interpreted
• Name and credentials of the interpreting practitioner
• A detailed written report of the findings and recommendations
• Clear indication that the interpreting provider was not involved in capturing the image

Common clinical scenarios include:

• Referral to a maxillofacial radiologist for complex pathology review
• Second opinions on impacted teeth or TMJ disorders
• Pre-surgical planning requiring expert radiologic input

Always retain a copy of the image and the interpretation report in the patient’s chart for audit and claims support.

Insurance Billing Tips

Billing for D0391 requires attention to detail to avoid denials or delays. Here are best practices:

• Verify coverage: Not all dental plans reimburse for D0391. Check with the patient’s insurance during the verification process.
• Submit supporting documentation: Attach the interpretation report and a copy of the image with your claim.
• Use correct provider information: The interpreting provider’s NPI and credentials must be listed on the claim, distinct from the provider who captured the image.
• Appeal denials: If a claim is denied, review the EOB for the reason, gather additional documentation if needed, and submit a timely appeal with a clear explanation of the code’s use.

For related codes, such as those for image capture or technical procedures, refer to our article on D0340 for cone beam CT capture.

Example Case for D0391

Consider a patient who presents with a complex jaw lesion. The general dentist takes a panoramic X-ray but refers the image to an oral and maxillofacial radiologist for expert interpretation. The radiologist, who did not capture the image, reviews it and provides a detailed report. The dental office bills D0391 for the interpretation service, attaching the radiologist’s report and the image to the claim. This ensures accurate diagnosis, optimal patient care, and appropriate reimbursement for the specialist’s expertise.

By understanding and correctly applying the D0391 dental code, dental practices can enhance patient care, streamline billing, and maximize insurance reimbursement for specialized diagnostic services.