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Question on initial visit with oral surgeon.

May 27, 2025 by Anonymous

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  • Question on initial visit with oral surgeon.

Question on initial visit with oral surgeon.

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Dentist referred me to an oral surgeon who was out of network so I choose a different surgeon. I had a referral to the first oral surgeon but not for the actual provider seen. My initial visit was coded as D9310 which is not covered by my insurance, the dentist had already established the diagnosis and recommended treatment. A second opinion or consultation between surgeon and dentist was not requested or needed. Shouldn’t they have used D0160.

I should note, I had to schedule with another oral surgeon as my treatment plan documented only the lowest cost procedure out of eight as covered by insurance and the other seven procedures shown as not covered. They refused to send treatment plan and necessary documention to my dental insurance for a pre-determination and expected me to pay approximately $4,000 up front and they would refund me any difference. I had serious doubt that the required documentation would be submitted with the claim. Additionally, they are withholding a percentage of my initial deposit as I had cancelled my procedure which I am fighting.

I have done medical coding for many years but dental coding seems to be complicated.

Thank you!!!

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Posted by lambtd01
Asked on May 27, 2025 11:35 am
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Hello! Since you were referred to the specialist by another provider, and not seen by the original referring dentist, the code D9310 (Consultation- Diagnostic service provided by dentist or physician other than requesting dentist or physician) was appropriately applied. Alternatively, D0160 ( Detailed and extensive oral evaluation, problem-focused, by report) could also be used, as both codes are valid depending on the documentation and clinical situation. Offices may choose either based on how the visit is documented. You will catch on to dental coding quickly because you have a medical coding background! There is a way to submit a preauthorization to your dental insurance on your behalf, although the dental office usually will do this for patients, depending on if they are contracted with that specific insurance. Let me know if you want me to walk you through the pre-auth I would be happy to assist! :)

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Posted by Austinida
Answered on June 17, 2025 8:02 am
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    Hello! Since you were referred to the specialist by another provider, and not seen by the original referring dentist, the code D9310 (Consultation- Diagnostic service provided by dentist or physician other than requesting dentist or physician) was appropriately applied. Alternatively, D0160 ( Detailed and extensive oral evaluation, problem-focused, by report) could also be used, as both codes are valid depending on the documentation and clinical situation. Offices may choose either based on how the visit is documented. You will catch on to dental coding quickly because you have a medical coding background! There is a way to submit a preauthorization to your dental insurance on your behalf, although the dental office usually will do this for patients, depending on if they are contracted with that specific insurance. Let me know if you want me to walk you through the pre-auth I would be happy to assist! :)

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    Posted by Austinida
    Answered on June 17, 2025 7:50 am
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      Hello! Since you were referred to the specialist by another provider, and not seen by the original referring dentist, the code D9310 (Consultation- Diagnostic service provided by dentist or physician other than requesting dentist or physician) was appropriately applied. Alternatively, D0160 ( Detailed and extensive oral evaluation, problem-focused, by report) could also be used, as both codes are valid depending on the documentation and clinical situation. Offices may choose either based on how the visit is documented. You will catch on to dental coding quickly because you have a medical coding background! There is a way to submit a preauthorization to your dental insurance on your behalf, although the dental office usually will do this for patients, depending on if they are contracted with that specific insurance. Let me know if you want me to walk you through the pre-auth I would be happy to assist! :)

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      Posted by Austinida
      Answered on June 17, 2025 7:48 am
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