Understanding Dental Code D8690

When to Use D8690 dental code

The D8690 dental code is designated for "Orthodontic treatment (alternative billing to a contract fee)." Unlike comprehensive orthodontic codes that cover the entire course of treatment under a single contract fee, D8690 is used when billing for orthodontic services that do not fit into a typical contract arrangement. This code is most appropriate in scenarios where treatment is provided on a non-contractual, fee-for-service basis, such as when a patient transfers into or out of your practice mid-treatment, or when only limited orthodontic services are rendered.

Practices should use D8690 when:

• A patient is continuing orthodontic care started elsewhere (transfer cases).
• Only a portion of the full orthodontic treatment is being provided.
• There is no comprehensive contract or global fee for the entire treatment.

Documentation and Clinical Scenarios

Accurate documentation is critical when using D8690. Dental teams should clearly outline the specific services rendered, the start and end dates of treatment phases, and the rationale for using an alternative billing approach. Common clinical scenarios include:

• Transfer Cases: A patient moves to your office with active orthodontic appliances. Document the appliances present, treatment progress, and any new diagnostic records taken.
• Limited Orthodontic Services: Only certain aspects of care are provided, such as debonding or retainer fabrication. Specify which procedures were performed and why comprehensive treatment was not billed.

Always include detailed clinical notes, diagnostic images, and a clear explanation in the claim narrative to support the use of D8690. This documentation is essential for insurance review and for minimizing claim denials.

Insurance Billing Tips

Billing D8690 requires a strategic approach to maximize reimbursement and minimize delays. Here are best practices:

• Verify Coverage: Before submitting a claim, confirm the patient’s orthodontic benefits and any limitations on alternative billing arrangements.
• Submit a Detailed Claim: Attach supporting documentation, including clinical notes, radiographs, and a narrative explaining the non-contractual nature of the services.
• Use Correct CDT Codes: If additional procedures are performed (e.g., orthodontic retention), bill them separately with the appropriate codes.
• Monitor EOBs and AR: Track Explanation of Benefits (EOBs) closely and follow up promptly on any denied or underpaid claims. Be prepared to submit claim appeals with additional documentation if needed.

Clear communication with both the patient and the insurer about the nature of the billing is key to avoiding confusion and payment delays.

Example Case for D8690

Case Scenario: A 15-year-old patient relocates and transfers orthodontic care to your practice. The patient has 12 months of active treatment remaining, with braces already in place. Your office assumes responsibility for the remainder of the treatment, but no comprehensive contract is established. Instead, you bill monthly for ongoing adjustments and monitoring.

How to Bill: Use D8690 for each month’s service, documenting the specific procedures performed at each visit. Include a narrative explaining the transfer situation and lack of a global contract. Attach progress notes and photos as supporting documentation. This approach ensures compliance with CDT guidelines and increases the likelihood of insurance reimbursement.

By understanding and correctly applying the D8690 dental code, dental teams can streamline billing for non-traditional orthodontic cases, reduce claim denials, and maintain a smooth revenue cycle.