When is D9935 used?
The D9935 dental code applies to cleaning and examining removable partial dentures in the lower jaw. This code is appropriate when patients come in for maintenance of their mandibular partial denture, involving comprehensive cleaning and clinical assessment of the appliance. This code excludes adjustments, repairs, or relines, which have separate CDT codes. Apply D9935 for preventive services, often during regular recall or hygiene visits, to maintain the prosthesis in good condition and detect potential problems early.
D9935 Charting and Clinical Use
Proper documentation is essential for effective billing and quality patient care. When applying D9935, dental staff should record these details in the patient chart:
Service date and affected arch (mandibular)
Specific type of removable partial denture serviced
Cleaning method details (such as ultrasonic cleaning, polishing procedures)
Inspection results (including wear patterns, fractures, fit assessment, tissue condition)
Treatment recommendations or future care plans
Typical clinical situations involve patients following 6-month maintenance schedules, individuals with previous denture irritation issues, or patients struggling with home care of their appliance. Complete documentation validates the service necessity and facilitates insurance claim processing.
Billing and Insurance Considerations
To ensure smooth reimbursement, implement these recommended practices when submitting D9935:
Confirm benefits: Many dental insurance plans exclude partial denture maintenance coverage. Verify patient eligibility and service frequency limits prior to treatment.
Code accurately: Do not combine D9935 with unrelated services. When cleaning both upper and lower partials, apply the appropriate code for each arch separately.
Include supporting records: Provide clinical documentation and intraoral photographs when available to justify the cleaning and inspection services.
Examine EOBs thoroughly: When claims are rejected, review the explanation of benefits for denial reasons and submit appeals with additional supporting materials when warranted.
Monitor receivables: Track outstanding accounts to ensure prompt follow-up on pending claims.
Clear patient communication regarding insurance coverage and personal financial responsibility helps prevent misunderstandings and enhances patient satisfaction.
How dental practices use D9935
Practice Example: A 68-year-old patient arrives for their scheduled hygiene visit wearing a lower removable partial denture. The dental hygienist carefully removes the appliance, conducts ultrasonic cleaning, examines it for damage and wear, and evaluates how it fits against the oral tissues. Clinical records document the complete cleaning procedure and inspection results, noting no repairs are necessary. The practice submits D9935 with complete clinical documentation after confirming the patient's insurance allows one partial denture cleaning annually. The claim processes smoothly, and the patient books their next maintenance appointment.
This scenario demonstrates how proper documentation, insurance verification, and transparent communication with patients and insurance providers leads to successful D9935 billing.
Common Questions
Can D9935 be billed alongside other dental procedures on the same day?
D9935 can typically be billed with other dental services performed on the same date, including routine examinations or cleanings, as long as each procedure is properly documented and medically necessary. Keep in mind that certain insurance carriers may have bundling restrictions or frequency limits, so verify payer-specific policies prior to submitting claims for multiple same-day services.
Is patient consent necessary before performing and billing D9935?
Although formal written consent isn't usually mandated for partial denture cleaning and inspection services, best practice involves informing patients about the procedure and potential costs, particularly when insurance coverage is questionable. Recording verbal consent and patient comprehension in clinical documentation helps prevent confusion and supports proper billing practices.
What steps should be taken if issues are identified during D9935 inspection?
When problems like cracks, fractures, or fitting issues are discovered during D9935 inspection, thoroughly document all findings in the patient record. Review the situation with the patient and discuss appropriate next steps, which might involve scheduling follow-up appointments for repairs, adjustments, or relining procedures. Ensure proper CDT codes are used for any additional treatments performed beyond the basic cleaning and inspection service.