Understanding Dental Code D9973

When to Use D9973 dental code

The D9973 dental code is designated for external bleaching procedures, specifically when performed per arch. This CDT code should be used when a patient elects to have their teeth whitened for cosmetic reasons, and the bleaching is applied externally to the enamel surface. It is important to note that D9973 is not intended for internal bleaching of non-vital teeth or for over-the-counter whitening products dispensed by the office. Use D9973 only when the procedure involves professional-grade materials and is performed or supervised by a licensed dental professional.

Documentation and Clinical Scenarios

Accurate documentation is essential for proper billing and compliance. When using D9973, include the following in the patient record:

• Detailed clinical notes describing the patient’s initial shade and desired outcome
• The type and concentration of bleaching agent used
• Number of arches treated (upper, lower, or both)
• Patient consent for cosmetic treatment
• Pre- and post-treatment photographs (if possible)

Common clinical scenarios for D9973 include patients seeking aesthetic improvement for special occasions, such as weddings or job interviews, or those dissatisfied with tooth discoloration from aging, diet, or medication. Always clarify that this is an elective, cosmetic procedure, as this distinction impacts insurance coverage.

Insurance Billing Tips

Most dental insurance plans do not cover external bleaching procedures billed under D9973, as they are considered cosmetic. However, it is best practice to verify each patient’s benefits before treatment. Here are actionable steps for billing D9973:

• Insurance Verification: Call the patient’s insurer or check the online portal to confirm if any cosmetic benefits exist.
• Pre-Treatment Estimates: Submit a pre-authorization or pre-determination request to obtain a formal denial, which can help with patient acceptance and transparency.
• Patient Communication: Clearly explain out-of-pocket costs and have the patient sign a financial agreement before proceeding.
• Claim Submission: If submitting a claim, use the D9973 code and include all supporting documentation, even if reimbursement is unlikely. This ensures a clear record for both the practice and the patient.
• Handling EOBs: Review Explanation of Benefits (EOBs) promptly. If the claim is denied, keep the denial on file for reference and patient communication.

Example Case for D9973

Consider a 35-year-old patient who requests professional whitening before a major life event. After a comprehensive exam, the dentist determines the patient is a good candidate for external bleaching. The office documents the initial shade, discusses realistic outcomes, and obtains written consent. The patient’s insurance is verified, and it is confirmed that bleaching is not a covered benefit. The patient is informed of the cost and agrees to proceed. The dental team performs external bleaching on both arches using a professional-strength gel, records the procedure under D9973, and provides post-treatment care instructions. The claim is submitted for documentation purposes, and the EOB denial is kept in the patient’s file for transparency.

By following these steps, dental practices can ensure accurate billing, clear patient communication, and proper documentation when using the D9973 dental code for external bleaching.