Understanding Dental Code D9311

When to Use D9311 dental code

The D9311 dental code is used when a dentist consults with a medical health care professional about a patient’s oral health condition. This code is specifically for situations where the dental provider communicates directly—either verbally or in writing—with a physician, nurse practitioner, or other medical professional to coordinate care that impacts the patient’s dental treatment plan. D9311 should not be used for routine referrals or standard communication; it is reserved for cases where the patient’s medical status requires collaborative management, such as complex medical histories, systemic conditions affecting dental care, or medication interactions.

Documentation and Clinical Scenarios

Accurate documentation is essential when billing D9311. The dental office should record the reason for the consultation, the details of the communication (date, time, method), and the outcome or recommendations provided by the medical professional. Best practice is to include a copy of any written correspondence or a summary of the verbal discussion in the patient’s chart. Common clinical scenarios include:

• Coordinating care for patients with bleeding disorders before oral surgery
• Discussing antibiotic prophylaxis for patients with cardiac conditions
• Reviewing medication changes for patients undergoing cancer treatment
• Managing dental care for patients with uncontrolled diabetes

In each case, thorough documentation supports the necessity of the consultation and strengthens the claim if it is reviewed or appealed.

Insurance Billing Tips

Billing D9311 successfully requires attention to detail and proactive communication with payers. Here are step-by-step best practices:

1. Verify coverage: Before submitting a claim, check the patient’s dental benefits to confirm if D9311 is a covered service. Not all plans reimburse for interprofessional consultations.
2. Submit supporting documentation: Attach detailed notes or correspondence with the claim to demonstrate medical necessity. This increases the likelihood of approval and expedites processing.
3. Use correct coding: Ensure D9311 is not billed in conjunction with codes that would be considered duplicative, such as routine exam codes. If multiple consultations occur, document each separately.
4. Monitor EOBs and AR: Review Explanation of Benefits (EOBs) promptly. If D9311 is denied, check for missing documentation or payer-specific requirements, and initiate a claim appeal with additional information as needed.

Staying current with payer policies and maintaining clear records helps dental teams minimize denials and maximize reimbursement.

Example Case for D9311

Consider a patient scheduled for periodontal surgery who has a history of heart valve replacement. The dentist contacts the patient’s cardiologist to confirm the need for antibiotic prophylaxis and to discuss any contraindications. The conversation is documented in the patient’s chart, including the date, time, and recommendations received. The dental office submits a claim for D9311, attaching a summary of the consultation and the cardiologist’s written response. This clear, thorough approach demonstrates medical necessity and supports successful reimbursement.

By understanding when and how to use D9311, dental practices can ensure proper care coordination and optimize their billing processes.