Understanding Dental Code D9248

When to Use D9248 dental code

The D9248 dental code is designated for non-intravenous conscious sedation in dental procedures. This code should be used when a patient requires sedation that is not administered intravenously but still achieves a conscious, cooperative state. Common methods include oral sedatives or inhalation agents such as nitrous oxide and oxygen. D9248 is appropriate for patients who experience significant anxiety, have special healthcare needs, or require lengthy or complex dental treatments where minimal sedation is insufficient but general anesthesia is not warranted.

Documentation and Clinical Scenarios

Accurate documentation is critical when billing with D9248. The clinical record should clearly state:

• The indication for sedation (e.g., dental anxiety, special needs, extensive procedures)
• The method and agent(s) used (e.g., oral midazolam, nitrous oxide/oxygen)
• Dosage, route of administration, and time of administration
• Patient monitoring details (vital signs, level of consciousness)
• Start and end times of sedation
• Any adverse events or complications

Common clinical scenarios include pediatric patients undergoing multiple restorations, adults with dental phobia, or patients with developmental disabilities who cannot tolerate routine dental care. Always ensure the documentation supports the medical necessity of non-IV conscious sedation and that the provider is properly credentialed to administer sedation.

Insurance Billing Tips

Billing D9248 successfully requires attention to payer policies and proper claim preparation. Here are best practices:

• Verify coverage: Before treatment, confirm with the patient’s dental insurance whether D9248 is a covered benefit. Many plans limit sedation coverage to specific clinical indications or patient populations (e.g., children under 6, patients with certain medical conditions).
• Pre-authorization: If required, submit a pre-authorization with supporting documentation outlining the need for sedation, planned procedure, and patient’s medical/dental history.
• Claim submission: On the claim form, use D9248 with a detailed narrative and attach clinical notes. Include the treating provider’s sedation permit or license if requested by the payer.
• Appeals: If a claim is denied, review the Explanation of Benefits (EOB) for denial reasons. Submit an appeal with additional documentation, such as letters of medical necessity or supporting literature, to demonstrate the appropriateness of non-IV sedation.

Stay current with payer guidelines, as coverage for sedation can vary significantly between dental benefit plans.

Example Case for D9248

Case: A 7-year-old patient with severe dental anxiety presents for multiple extractions and restorations. The dentist determines that oral sedation with midazolam, combined with nitrous oxide/oxygen, is necessary to safely complete the treatment. The clinical notes document the patient’s anxiety, the sedation protocol, monitoring, and successful completion of care without complications.

Billing steps:

1. Verify the patient’s insurance covers D9248 for pediatric sedation.
2. Obtain pre-authorization with a detailed narrative and supporting documentation.
3. Submit the claim with D9248, attach clinical notes, and include the provider’s sedation credentials.
4. If denied, review the EOB and submit an appeal with additional justification.

This process ensures compliance, maximizes reimbursement, and supports the patient’s care needs.