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How to Use the Dental Code D9311

What is D9311?

According to the ADA, the code D9311 is used when a dental provider consults with a medical health care professional.

How can a dentist use it?

A dentist may use this code when they consult with a patient’s medical provider through telehealth. Typically the dental provider would consult with the patient’s medical provider, before initiating dental treatment, to discuss a patient’s medical conditions and collaborate on a treatment plan to ensure comprehensive patient safety.

According to the American Dental Coders Association, the consult must be recorded in the patient’s dental chart notes as a document, audio, or video file. Details that must be documented are: patient’s medical history, medical and dental exam history, proposed dental treatment, consulting physician, length of consultation, and treatment decisions.

For example, a dentist may provide a limited exam (via telehealth or in-person) for a patient who is also undergoing radiation and chemotherapy to treat cancer. After the limited exam, if the dentist decides the patient needs further treatment, it would benefit the patient and dental provider if the provider consulted with the patient’s oncologist. A consultation between the dental and medical provider would allow the dentist to understand the extent of the patient’s cancer therapy, any oral health risks associated with the treatment, and creation of a collaborative treatment plan to benefit the patient’s systemic and oral health.

What insurance payers cover this code during COVID-19?

Currently, only a few providers cover D9311 during the COVID-19 pandemic:

  • Anthem
  • Blue Cross NC/Dental Blue
  • DentaQuest
  • Dominion National
  • Humana
  • Liberty
  • MetLife

Based on ADA guidance

Disclaimer: coverage subject to state laws, practice acts and individual policies

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