When is D9993 used?
The D9993 dental code applies to dental case management services aimed at encouraging patient adherence and enhancing oral health results. This CDT code covers situations where dental professionals deliver personalized, patient-focused case management activities—including care coordination, appointment scheduling assistance, or providing educational support to patients with complicated healthcare needs. D9993 proves particularly valuable for patients requiring extra help to complete recommended treatments, including individuals with ongoing health issues, multiple care providers, or access challenges.
D9993 Charting and Clinical Use
Proper documentation remains crucial when submitting claims for D9993. Clinical records must clearly describe the particular case management tasks completed. Common examples include:
Managing referrals to specialty providers or additional healthcare professionals
Organizing transportation assistance or interpreter services for visits
Delivering customized oral care instructions based on individual patient requirements
Contacting patients who missed scheduled visits or managing complex medical backgrounds
Recommended practice involves recording the date, time spent, and type of service provided, along with results or patient feedback. For example, "On 3/15/24, case manager dedicated 20 minutes to organizing oral surgery consultation and verifying patient transportation arrangements. Patient acknowledged instructions and visit was booked." Such thorough documentation helps support claims during insurance evaluations or compliance reviews.
Billing and Insurance Considerations
Processing D9993 claims demands a thoughtful strategy to optimize payment and reduce rejections. Consider these practical recommendations:
Confirm Benefits: Prior to delivering case management services, contact the patient's insurer to verify D9993 coverage. Certain policies may need prior approval or have particular documentation standards.
Provide Complete Claims: Include thorough clinical documentation and supporting materials like referral paperwork or interaction records when possible. This evidence helps demonstrate service necessity.
Examine EOBs Thoroughly: When claims get denied, study the Explanation of Benefits for the exact rejection cause. Frequent problems include insufficient documentation or excluded services.
File Appeals When Justified: If the service was clinically appropriate, submit an appeal with extra documentation and clear explanation of patient requirements and delivered services.
Monitor Outstanding Claims: Keep track of accounts receivable for pending D9993 submissions and address any problems quickly.
How dental practices use D9993
Think about a diabetic patient with gum disease who has difficulty maintaining appointments and following home care recommendations. The dental practice applies D9993 to bill for time invested in:
Communicating with the patient's family doctor and diabetes specialist
Arranging return appointments and providing appointment reminders
Offering tailored education about diabetes and oral health connections
Every interaction gets recorded in the patient record, and the claim contains a description of case management work performed. This method supports payment while improving patient care by removing obstacles to treatment.
For additional case management codes, review D9992 dental code for care coordination procedures.
Common Questions
Is it possible to bill D9993 together with other dental procedure codes?
Yes, D9993 can frequently be billed with other dental procedure codes, as long as the case management services are clearly separate and independently documented from the clinical procedures being performed. Make sure your documentation clearly distinguishes the case management activities from other billable services to prevent claim rejections due to duplicate or bundled services.
Which dental team members are authorized to provide and document D9993 services?
D9993 case management services may be delivered by different dental team members, including dentists, dental hygienists, or appointed case managers. The essential requirement is that the person delivering the service is properly qualified and authorized according to state regulations and practice guidelines to coordinate patient care and maintain proper documentation in the patient's medical record.
What is the billing frequency allowed for D9993 per patient?
How frequently D9993 can be billed varies based on the patient's continuing requirements and the insurance provider's particular guidelines. Certain insurance plans may restrict how many times D9993 can be billed annually or per treatment episode. Always confirm with the insurance provider and ensure each billed occurrence is backed by comprehensive documentation of new or ongoing case management services.