Understanding Dental Code D9410

When to Use D9410 dental code

The D9410 dental code is designated for a dental professional’s visit to a patient residing in a house or extended care facility, such as a nursing home or assisted living center. This CDT code is specifically used when the dentist travels to the patient, rather than the patient visiting the dental office. D9410 should be reported only for the actual trip to the facility, not for the dental procedures performed during the visit. Each trip to a different facility or location warrants a separate D9410 entry.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful reimbursement when using D9410. Dental offices should record the following details in the patient’s chart:

• Date and time of the visit
• Exact location (facility name and address)
• Reason for the house or facility call (e.g., patient’s mobility limitations, medical necessity)
• All dental services rendered during the visit, each with the appropriate CDT code (e.g., periodic oral evaluation)

Common clinical scenarios include treating elderly patients in nursing homes, providing care for individuals with disabilities, or addressing urgent dental needs in hospice settings. Always ensure that the need for a facility visit is clearly justified in the clinical notes to support claim approval.

Insurance Billing Tips

Billing D9410 requires attention to payer-specific guidelines. Here are best practices for maximizing reimbursement:

• Verify coverage: Before scheduling, confirm with the patient’s insurance whether D9410 is a covered benefit and if preauthorization is required.
• Submit detailed claims: Include comprehensive documentation, such as the facility’s address, reason for the visit, and supporting clinical notes.
• Use separate codes: Bill D9410 in addition to the codes for procedures performed during the visit. Do not bundle D9410 with other services.
• Review EOBs: Carefully review Explanation of Benefits statements for denials or partial payments. If denied, use the information to file a claim appeal with additional documentation.
• Track AR: Monitor accounts receivable to ensure timely payment and follow up promptly on unpaid claims.

Some payers may have limitations on the frequency of D9410 or require specific justification. Always keep up-to-date with payer policies and CDT code changes.

Example Case for D9410

Dr. Smith’s dental office receives a request from a local assisted living facility to see a patient who cannot travel due to advanced dementia. The office verifies with the patient’s insurance that D9410 is covered and obtains preauthorization. On the day of the visit, Dr. Smith documents the facility’s name, address, and the clinical reason for the house call. In addition to D9410, the office bills for a limited oral evaluation and a palliative treatment performed during the visit. The claim is submitted with thorough documentation, resulting in prompt payment for both the facility call and the dental procedures.

By following these steps, dental offices can ensure accurate billing and maximize reimbursement for house or extended care facility calls using D9410.