Understanding Dental Code D9310

When to Use D9310 dental code

The D9310 dental code is designated for a consultation provided by a dentist or dental specialist. This CDT code is used when a patient is referred by another dentist or physician for a diagnostic opinion or advice regarding a specific dental problem. It is important to note that D9310 is not intended for routine new patient exams or second opinions without a formal referral. Instead, it should be reserved for situations where the referring provider requests a detailed evaluation and report.

Common scenarios for using D9310 include complex treatment planning, interdisciplinary cases, or when a general dentist seeks a specialist’s input on a challenging diagnosis. Always confirm that the consultation is medically necessary and that the referring provider’s information is documented in the patient’s chart.

Documentation and Clinical Scenarios

Proper documentation is crucial for successful reimbursement of D9310. The patient’s chart should include:

• The name and contact information of the referring provider
• The reason for the consultation
• A detailed narrative of findings, recommendations, and any diagnostic tests performed
• A copy of the report sent to the referring provider

Clinical scenarios where D9310 is appropriate include:

• A periodontist evaluating a patient referred by a general dentist for advanced gum disease management
• An oral surgeon consulted for a complex extraction or pathology review
• An orthodontist providing a diagnostic opinion on a patient’s malocclusion at the request of a pediatric dentist

Remember, a comprehensive exam (D0150) or limited exam (D0140) should not be billed in place of D9310 when a true consultation is performed.

Insurance Billing Tips

To maximize reimbursement for D9310, follow these best practices:

• Verify coverage: Not all dental plans cover consultations. Check eligibility and benefits before the appointment.
• Submit supporting documentation: Attach the referral letter, consultation narrative, and any diagnostic images to the claim.
• Use correct provider information: Ensure both the referring and consulting provider details are accurate on the claim form.
• Appeal denials: If the claim is denied, review the Explanation of Benefits (EOB) and submit an appeal with additional documentation if necessary.
• Do not double-bill: Avoid billing D9310 in conjunction with other exam codes for the same visit unless specifically allowed by the payer.

Staying proactive with insurance verification and thorough documentation can help reduce Accounts Receivable (AR) delays and improve claim acceptance rates.

Example Case for D9310

Consider a patient referred by their general dentist to a periodontist for evaluation of severe periodontal disease. The periodontist reviews the referral, examines the patient, performs necessary diagnostics, and provides a written report with treatment recommendations back to the referring dentist. In this scenario, billing D9310 is appropriate, provided all documentation requirements are met and the payer’s guidelines are followed.

By understanding when and how to use the D9310 dental code, dental practices can ensure accurate billing, reduce claim denials, and support collaborative patient care.