When is D9248 used?
The D9248 dental code applies to non-intravenous conscious sedation during dental treatments. This code is utilized when patients need sedation delivered through non-IV methods while maintaining a conscious and cooperative state. Typical delivery methods include oral medications or inhalation techniques like nitrous oxide with oxygen. D9248 fits situations involving patients with high anxiety levels, those with special medical conditions, or individuals requiring extended or complicated dental work where basic sedation proves inadequate but full anesthesia remains unnecessary.
D9248 Charting and Clinical Use
Proper documentation remains essential when using D9248 for billing purposes. Clinical records must clearly include:
Reason for sedation use (such as patient anxiety, special medical needs, complex procedures)
Sedation technique and medications used (such as oral midazolam, nitrous oxide with oxygen)
Medication amounts, delivery method, and timing of administration
Patient monitoring records (vital signs, consciousness levels)
Beginning and ending times for sedation period
Documentation of any complications or adverse reactions
Typical clinical situations involve young patients needing multiple tooth repairs, anxious adults with dental fears, or individuals with developmental challenges who struggle with standard dental care. Always confirm that documentation demonstrates medical necessity for non-IV conscious sedation and verify that the treating provider holds appropriate sedation credentials.
Billing and Insurance Considerations
Successfully billing D9248 demands careful attention to insurance requirements and thorough claim preparation. Consider these guidelines:
Check coverage: Prior to treatment, confirm whether the patient's dental plan covers D9248 as a benefit. Many insurance policies restrict sedation coverage to particular medical reasons or specific patient groups (such as young children or patients with certain health conditions).
Prior approval: When necessary, request pre-approval by submitting supporting materials that explain the sedation need, planned treatment, and patient's health history.
Filing claims: Include D9248 on claim forms with comprehensive descriptions and attach relevant clinical documentation. Provide the practitioner's sedation certification or license when requested by insurers.
Claim appeals: For denied claims, examine the benefits explanation to understand rejection reasons. File appeals with supplementary documentation, including medical necessity letters or research evidence, to justify the appropriateness of non-IV sedation.
Keep updated on insurance policies, since sedation coverage differs considerably among dental benefit programs.
How dental practices use D9248
Scenario: A 7-year-old child with intense dental fear requires several tooth extractions and fillings. The dental provider decides that oral midazolam sedation combined with nitrous oxide and oxygen is essential for safe treatment completion. Clinical documentation records the child's anxiety level, sedation approach, patient monitoring, and successful treatment without adverse events.
Processing steps:
Confirm the patient's insurance plan covers D9248 for children's sedation needs.
Secure prior approval using detailed explanations and supporting clinical information.
Process the claim using D9248, include clinical documentation, and provide practitioner sedation qualifications.
For claim rejections, examine the benefits explanation and file an appeal with additional supporting evidence.
This approach ensures proper compliance, optimizes payment potential, and supports appropriate patient treatment.
Common Questions
Is it possible to bill D9248 alongside other sedation procedure codes?
D9248 cannot be billed simultaneously with general anesthesia or deep sedation codes. When intravenous sedation is administered, the appropriate code would be D9243 rather than D9248. Healthcare providers should select the code that best represents the actual sedation technique utilized during treatment.
Does D9248 have any patient age limitations for billing purposes?
D9248 has no inherent age restrictions and may be applied to patients of all ages, including children and adults. The key requirement is proper documentation of clinical necessity for non-IV conscious sedation, along with verification that the chosen sedation approach is suitable for the patient's age group and overall health condition.
What are the proper consent procedures for D9248 sedation services?
Prior to providing non-intravenous conscious sedation, dental practices must secure informed consent from either the patient or their authorized legal representative. This consent documentation should clearly describe the sedation technique being used, associated risks, available treatment alternatives, and must be properly recorded in the patient's clinical file to meet standard risk management and regulatory compliance requirements.