D9973 Dental Code
In the world of dental billing and coding, precision is key. One often misunderstood but crucial code is D9973, designated for “dental office visits without treatment.” Unlike routine exams or procedures, this code applies when a patient visits the dentist for consultations, follow-ups, or administrative purposes without receiving active treatment.
Why is this important? Misusing or overlooking D9973 can lead to billing errors, claim denials, or even compliance issues. This guide explores everything dentists, hygienists, and billing specialists need to know about D9973—from its definition to billing best practices.
2. Understanding the D9973 Dental Code
Definition & Purpose
The D9973 code falls under the American Dental Association (ADA) Current Dental Terminology (CDT) and is classified as a “non-treatment” visit. It is used when:
- A patient comes in for a consultation but does not undergo any procedures.
- A follow-up visit is needed to monitor healing without additional treatment.
- Administrative discussions (e.g., treatment planning, insurance questions) occur without clinical intervention.
When Is It Used?
| Scenario | Applicable? |
|---|---|
| Post-op checkup (no treatment provided) | ✅ Yes |
| Consultation for cosmetic dentistry | ✅ Yes |
| Emergency visit with only an exam (no treatment) | ✅ Yes |
| Routine cleaning or filling | ❌ No |
3. Key Differences Between D9973 and Other Dental Codes
Many dental professionals confuse D9973 with similar codes like D0140 (limited oral evaluation) or D0150 (comprehensive exam). However:
- D0140/D0150 involve clinical assessments (e.g., X-rays, periodontal probing).
- D9973 is strictly for non-clinical interactions.
Example: If a patient visits to discuss Invisalign options but doesn’t get scans or impressions, D9973 applies. If X-rays are taken, D0140 may be more appropriate.
4. Billing and Insurance Considerations
Insurance Coverage for D9973
Not all insurers reimburse for D9973, as it’s considered a non-procedural visit. Some key points:
- Medicaid & PPO Plans: Varies by provider; some consider it billable.
- HMO Plans: Rarely covered.
Common Reimbursement Challenges
- Denial Reason: “Not medically necessary.”
- Solution: Attach detailed notes explaining the visit’s purpose.
5. Clinical Applications of D9973
Patient Scenarios Where D9973 Applies
- Post-Surgical Checkup: Patient returns after extraction just for a healing review.
- Second Opinion Visit: No treatment performed, only discussion.
- Treatment Plan Review: Financial/insurance consultation without procedures.
Documentation Requirements
- Must include:
- Reason for visit
- Confirmation no treatment was provided
- Patient’s consent (if applicable)
6. Legal and Ethical Considerations
Compliance with ADA Guidelines
Misusing D9973 (e.g., billing it for actual treatment) can lead to fraud allegations.
Avoiding Fraudulent Billing
- Never use D9973 if any procedure (even minor) was performed.
- Keep detailed records to justify its use.
7. How Dentists Can Optimize the Use of D9973
Best Practices for Documentation
- Use SOAP notes (Subjective, Objective, Assessment, Plan).
- Clearly state: “No treatment rendered; visit for discussion only.”
Communicating with Patients
- Explain why they’re being billed for a “non-treatment” visit.
- Offer transparency to avoid disputes.
8. Frequently Asked Questions (FAQs)
Q1: Can D9973 be used for emergency visits?
✅ Yes, if only an evaluation occurs without treatment (e.g., pain assessment with no procedure).
Q2: Does Medicare cover D9973?
❌ No, Medicare does not cover routine dental visits.
Q3: How often can D9973 be billed per patient?
No strict limit, but frequent use may trigger audits.
9. Conclusion
The D9973 dental code is essential for accurate billing of non-treatment visits. Proper documentation, insurer communication, and ethical use ensure compliance and revenue integrity. By understanding its applications, dental practices can avoid claim denials and maintain transparency with patients.
10. Additional Resources
