When is D9996 used?
The D9996 dental code applies to asynchronous teledentistry services where patient data—including X-rays, clinical photos, or digital models—is gathered and securely sent to a dental professional for later review. This code is appropriate when there's no live communication between patient and dentist. Typical uses include remote second opinion consultations, dental emergency screening, or post-treatment evaluations where the dentist examines stored information and provides guidance without direct real-time contact.
D9996 Charting and Clinical Use
Proper record-keeping is crucial when using D9996. Patient files must clearly document:
What information was gathered (such as oral photographs, X-ray images, medical history).
When and how data was collected and sent.
The dentist's later evaluation, conclusions, and treatment advice.
Common clinical examples include dental hygienists taking pictures during school health checks that are forwarded to dentists for analysis, or patients submitting photos of surgical sites for healing assessment. In each situation, the dental professional examines the materials later and records their observations and next steps.
Billing and Insurance Considerations
When filing claims for D9996, use these strategies to improve payment success and reduce claim rejections:
Check plan benefits: Many dental insurers don't cover teledentistry services. Confirm coverage with each patient's insurance before delivering care.
Select the right CDT code: D9996 is exclusively for asynchronous teledentistry. Don't mix it up with D9995, which covers synchronous (live) teledentistry.
Include supporting records: Send treatment notes, photographs, and written explanations detailing why the asynchronous consultation was needed.
Monitor claim responses: Watch Explanation of Benefits statements for proper claim handling and quickly address any denied or underpaid claims in accounts receivable.
File appeals when needed: For denied claims, submit comprehensive appeals with records demonstrating clinical necessity and the benefit of the remote evaluation.
How dental practices use D9996
Take a young patient who experiences a small dental trauma during school hours. The school health aide takes mouth photos and gathers basic health information, then sends everything to the dental practice. The dentist examines these materials later that evening, concludes no urgent treatment is required, and provides home care instructions. This scenario demonstrates proper use of D9996 for billing the dentist's remote assessment and clinical decision-making.
Understanding the correct application of D9996 helps dental practices extend patient access, improve office efficiency, and receive proper payment for teledentistry care.
Common Questions
Can code D9996 be utilized for live video dental consultations?
No, D9996 is designated exclusively for asynchronous teledentistry services, where patient data is gathered and subsequently evaluated by a dental professional at a different time. Live video consultations require alternative codes, such as D9995.
Does D9996 carry a separate charge, or is it bundled with other dental procedures?
D9996 serves as an adjunctive code and must be billed alongside the primary procedure code (including radiographs or evaluations). It cannot be billed as a standalone service and requires proper documentation of the primary treatment provided.
How should dental practices handle insurance claim denials for D9996?
When a D9996 claim is denied, dental practices should examine the Explanation of Benefits (EOB) to identify the denial reason, compile any necessary supporting documentation, and file an appeal with the insurance company. Comprehensive documentation and effective communication with the insurer can enhance the likelihood of successful claim approval.